THE ASSOCIATION BETWEEN INFORMAL SUPPORT AND HEALTH CARE UTILIZATION: A DOUBLE-EDGED SWORD?

Abstract

AbstractThe literature presents two opposing explanations of the inter-relationship between informal and formal care. One claims that informal care provides the bulk of health care, leading to lower reliance on formal care. The other maintains that help given by the informal sector can enable formal care and result in higher use of formal health services (e.g. Bonsang, 2009; Li & Chi, 2011). Examination of this association, taking into account the extent of need on the part of the care recipient as well, presents a more nuanced explanation of the relationship. Data for the current study was taken from two consecutive waves of the Survey of Health, Ageing and Retirement in Europe (SHARE) and focused on community-dwelling older Europeans aged 65+ (N = 15,758). OLS regression models predicted change in doctor visits and hospitalizations over two years (2013 and 2015). These were predicted using an interaction between informal social support and physical limitations, controlling for socio-demographic factors. The interaction results revealed that social support lowered healthcare utilization only when limitations were high, but predicted higher utilization when limitations were low. The analyses thus underscore a complex association between informal support and healthcare utilization. Social support seems to decrease health service use when older adults are more severely limited. However, support may be a double-edged sword, as individuals who receive support but are relatively less impaired tend to turn to formal services more often. These results indicate that the informal care formal care nexus is conditioned by functional status.