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Substudy 3 Fact Sheet

Cost Implications of Informal Supports (NA101-03)

Sponsor Organization:

Hollander Analytical Services Ltd.


This project is one of fifteen sub-studies of the National Evaluation of the Cost-Effectiveness of Home Care Project (NA101). Sub-study 3 examined the relationship between the amount of formal home care services clients receive and the amount of informal (family) support provided.

A unique Edmonton data base of some 5,000 home care clients from the Capital Health Region in Edmonton, Alberta was used to study the comparative resource use of formal and informal home care services. Ideally, the analysis of the relationship between formal and informal care is determined experimentally. When this is not practical, a non-experimental database can be used but must contain sufficient variables to account for the selection bias. It must also contain sufficient descriptions of informal resources available to clients and amount of formal services provided. The Edmonton dataset met these criteria. Following a review of existing statistical methods to analyse the problem, a statistical approach that encompassed survival analysis, causal modeling and correction for selection bias was developed.

Key Findings:

The project leader identified the following outcomes:

  • Formal and informal care are complementary, not substitutive. In general, if a client gets more of one type of care, he or she will also receive more of the other type of care. Thus, increasing formal care does not decrease informal care.
  • An overall increase of $1 in informal care has a commensurate increase of $1.09 in formal care, while an increase of $1 in formal care has a commensurate increase of $0.30 in informal care.
  • For higher levels of care, increases in informal care still elicit significant increases in formal care, but increases in formal care only elicit modest increases in informal care.


The project leader indicated the findings are significant because, in his view:

  • They suggest that increasing the capacity to provide informal care does not generate savings to the formal care sector. Conversely, increasing formal care service intensity increases caregiver burden, although the mechanisms underlying these observations are not entirely clear.
  • There is a concern regarding involuntary conscription into caregiving , and addressing it will require implementation of policies that encourage capacity and willingness to provide care. Other policies might include examination of eligibility criteria, scope of services provided, and user fees.

Evaluation Methodology:

As this project was analytic/evaluative in nature, please see the "Activities" section.

HTF Contribution to the Project:

$1,505,000 (divided among the 15 sub-studies)

Language of Report: