Something for nothing? : the value of informal care

Objectives Many individuals with long-term care needs rely on informal care to support them in their daily living. Although public authorities tend to see informal care as free, caring imposes significant costs on caregivers. However, measuring and valuing informal care remains a challenge partly due to the absence of clear guidelines on the topic and partly due to the lack of consensus among economists on the best methods to use. This review describes the methods used to measure and monetarily value informal care and discusses their advantages and limitations. As this care is unpaid a direct monetary valuation of care input is not available. Economic evaluations which are undertaken from a health care perspective omit the resource use and costs of any informal care that is provided. Exclusion of these costs can result in reimbursement decisions which increase the demand for informal care and shifts hidden costs on to the informal care sector as, without a monetary valuation, this resource appears to be free. Methods Review of: (i) the methods available to measure time, (ii) methods available to value time spent in informal care, and (iii) application in published economic evaluations of care interventions. Results Only the diary and the recall methods have been used in cost-effectiveness analysis, although direct observation and experience sampling may provide more accurate estimates of time use. The traditional methods to value time are the opportunity cost, proxy good and contingent valuation methods. Recently, the well-being method and applications of conjoint analysis to informal care have been developed. The value of informal care varies widely depending on the methods used. Conclusions Informal care should not be viewed as costless or free since the time inputs into informal care generate costs borne by the caregiver and society as a whole. The monetary value of informal care can be estimated using existing methods. One clear advantage of using monetary valuation methods is that it be included in the cost side of economic evaluation. However, different methods give different answers both in terms of time-use data and value of informal care. Clear guidelines are needed on the preferred methods to measure and value informal care time.