Special Issue "The Economics of Caring"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: 15 September 2021.

Special Issue Editors

Prof. Dr. Pablo Moya Martinez
E-Mail Website
Guest Editor
Department of Economic Analysis and Finance, Universidad de Castilla-La Mancha, Cuenca, Spain
Interests: care financing; health care cost; long-term care cost; long-term care financing; chronic diseases
Prof. Dr. Raúl del Pozo Rubio
E-Mail Website
Guest Editor
Department of Economic Analysis and Finance, Universidad de Castilla-La Mancha, Cuenca, Spain
Interests: care financing; health care cost; long-term care cost; long-term care financing; chronic diseases

Special Issue Information

Dear Colleagues,

We are currently organising a Special Issue entitled “The Economics of Caring” in the International Journal of Environmental Research and Public Health. IJERPH is a peer-reviewed scientific journal that publishes articles and communications in the interdisciplinary area of environmental health sciences and public health. For detailed information on the journal, we refer you to https://0-www-mdpi-com.brum.beds.ac.uk/journal/ijerph.

From the very beginning of the lives of human beings, care is an essential and unavoidable activity. This task conditions the behaviour and roles assigned to each household member and the knowledge, training, and responsibility that accompany those roles. In this sense, caring transcends not only the action of providing help or attention to the caregiver, but also restricts the development of another potential activity of the caregiver (for example, employment, training, leisure, etc.). The sociodemographic changes we are experiencing and the facts discussed above have pushed states into rethinking the social protection systems that must be offered, raising questions about what kind of protection to give, who should give it (unpaid care work or paid care work), and how it should be provided. Finally, all this has an impact on the micro-, meso-, and macroeconomic spheres of families and, therefore, on the economic structure and well-being of each society.

Now we are in the year 2020, which represents the closure of a decade of profound revolutions in economic, financial, and political thinking derived from the subprime crisis among many other factors, accompanied by other equal or more intense riots in the social field, where family structures and social and health services have been questioned in terms of efficiency, equity, and extension or reduction of social rights. Therefore, within this context, analysis and evaluation of the tasks of caring for people with disabilities or dependency, caring for the elderly, or caring for people with diseases becomes a challenge for researchers in health economics. Allowing the economic impact of different casuistic trends that are involved in care to be made visible is necessary to be able to give the political decision-maker valuable, relevant, and complete information for the decision-making process and thus be able to design efficient actions that converge with the needs demanded by societies.

Finally, it is essential to mention that the economics of caring has been an increasing topic of interest in the last two decades. We should note that in submitting a query in PubMed with the text “economics” or “economic” and “caring” or “care” in the title or abstract of the indexed articles, we find that there is a significant increase in these works during the last decade of approximately 8.5% per year, reaching the figure of 3962 articles for the year 2019. Therefore, it is now an excellent time to provide, in a monograph, a global perspective of the subject, with an overview of the most-affected countries and of the latest methodological advances. In addition, other issues of interest will be addressed, including the following:

International perspectives of the economics of caring;

Specific studies for illness or particular population segments involved in care, including all kinds of costs (direct costs, e.g., healthcare costs; indirect costs, e.g., productivity losses; and intangible costs);

Methods for measuring the effects of care on health and equity, and for evaluating the impact of policies to address the need for care;

Impact of caring on the health of the caregivers;

Present and future trends of informal care: continuation and survival or extinction?

Informal and formal care: complementary or substitutive?

We welcome the submission of reviews, original research articles, short communications, case studies, and other kinds of articles targeting any of these core research questions and beyond. We would be delighted to attract as many diverse submissions representing different geographies and jurisdictions as possible.

Prof. Pablo Moya Martinez
Prof. Raúl del Pozo Rubio
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • equity of care social protection the economics of care cost of formal care cost of Informal care caregiver costs care Models costs of care financing of care care changes/care challenges economics of ageing economics of child care economics of Infant care care planning care in illness terminal care palliative care critical care care of illness prevention

Published Papers (13 papers)

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Research

Article
Health, Work, and Social Problems in Spanish Informal Caregivers: Does Gender Matter? (The CUIDAR-SE Study)
Int. J. Environ. Res. Public Health 2021, 18(14), 7332; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18147332 - 08 Jul 2021
Viewed by 487
Abstract
(1) Background: The aim of this study was (i) to analyze problems faced by informal caregivers in three areas of their life: health, work and finances, and family and social relationships, (ii) to investigate the main determinants of these problems, and (iii) to [...] Read more.
(1) Background: The aim of this study was (i) to analyze problems faced by informal caregivers in three areas of their life: health, work and finances, and family and social relationships, (ii) to investigate the main determinants of these problems, and (iii) to explore differences between men and women. (2) Methods: The study population consisted of people aged ≥18 years living in a family home who were providing unpaid care to a dependent person in the same or another home and who were registered as caregivers with the Primary Health Care District of Granada or the Provincial Council of Gipuzkoa. Several logistic regression models were built to analyze the likelihood of caregivers experiencing health, work-related, or social problems as a result of their caregiving responsibilities. (3) Results: Informal female caregivers were more likely to experience problems attributed to caregiving than their male counterparts, particularly in the areas of health and work. Additional factors associated with an increased likelihood of problems were low perceived social support, performance of ungratifying tasks, and fewer years as a caregiver. (4) Conclusions: Informal caregivers in Spain face significant problems as a result of their caregiving duties, and the impact on men and women is different. Policies and interventions to mitigate the negative effects of unpaid caregiving should incorporate differential strategies to meet the specific needs of male and female caregivers in different caregiving contexts. Full article
(This article belongs to the Special Issue The Economics of Caring)
Article
The Impact of Family Care for the Elderly on Women’s Employment from the Perspective of Bargaining Power
Int. J. Environ. Res. Public Health 2021, 18(11), 5905; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18115905 - 31 May 2021
Viewed by 651
Abstract
Due to the wishes of the elderly and the traditional family culture in China, family care is the main way of providing for the aged, and women’s care is the main way. This is not conducive to the protection of women’s employment rights [...] Read more.
Due to the wishes of the elderly and the traditional family culture in China, family care is the main way of providing for the aged, and women’s care is the main way. This is not conducive to the protection of women’s employment rights and the realization of self-worth under the background of increasing women’s autonomy. Based on the latest data of the China Health and Nutrition Survey Database (CHNS), this paper uses ordinary least squares (OLS) and the instrumental variable method of control endogeneity to analyze the influence of family care activities on the labor participation rate of married women. The innovation of this paper is to introduce family bargaining power into this kind of model for the first time, and further analyze the heterogeneity from the perspective of bargaining power differences. The empirical results show that the family elderly care activities have an obstacle effect on married women’s participation in employment, and the family members with strong bargaining power will significantly hinder employment, so this paper puts forward policy recommendations in line with the actual situation, hoping to provide theoretical support for the improvement of the social security system for the elderly. Full article
(This article belongs to the Special Issue The Economics of Caring)
Article
Non-Financial Support Provided to Parents in Stepfamilies: Empirical Examination of Europeans 50+
Int. J. Environ. Res. Public Health 2021, 18(10), 5151; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18105151 - 13 May 2021
Viewed by 475
Abstract
The aging of the population, coupled with increasing divorce and remarriage rates, are changing the structure of potential non-financial support for older parents. The purpose of this study was to examine support provided to parents aged 50+ in stepfamilies and to determine if [...] Read more.
The aging of the population, coupled with increasing divorce and remarriage rates, are changing the structure of potential non-financial support for older parents. The purpose of this study was to examine support provided to parents aged 50+ in stepfamilies and to determine if the difference existed between help provided by natural children and stepchildren. The primary objective was to investigate whether blood ties were a significant determinant of the support if the quality of the relationship between the parent and a natural child or a stepchild was taken into account. The secondary objective was to answer the question to what extent the reciprocal exchange motive of support was observed in stepfamilies. The probability of non-financial support from children and stepchildren was estimated based on the sixth wave of the SHARE (Survey on Health, Ageing, and Retirement in Europe) database for European countries. Children in stepfamilies provided less non-financial help to parents than those in intact families. Stepchildren were less likely to be in stepparents’ social networks, and stepparents provided less help with childcare for grandchildren than they did to their biological children. Relationship closeness and looking after grandchildren increased the probability of non-financial support to older parents, regardless of whether the donor was a natural child or a stepchild. Full article
(This article belongs to the Special Issue The Economics of Caring)
Article
Dependent, Poorer, and More Care-Demanding? An Analysis of the Relationship between Being Dependent, Household Income, and Formal and Informal Care Use in Spain
Int. J. Environ. Res. Public Health 2021, 18(8), 4339; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18084339 - 19 Apr 2021
Viewed by 713
Abstract
Population ageing is one of the current challenges that most societies are facing, with great implications for health systems and social services, including long-term care. This increasing long-term care use is particularly rising for dependent older people, motivating the implementation of regional dependency [...] Read more.
Population ageing is one of the current challenges that most societies are facing, with great implications for health systems and social services, including long-term care. This increasing long-term care use is particularly rising for dependent older people, motivating the implementation of regional dependency laws to ensure their care needs’ coverage. Using data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) from the year 2004 until 2017, the aim of this study is to assess the impact that the Spanish System for Personal Autonomy and Dependency might have on (i) household income, according to different needs for care levels, by running Generalized Linear Models (GLMs); and (ii) formal and informal care use depending on the income-related determinant through the performance of logit random-effects regression models. We show that the different degrees of needs for personal care are associated with a lower household income, being associated with an income reduction from €3300 to nearly €3800, depending on the covariates included, per year for the more severely in-need-for-care older adults. Moreover, our findings point towards a higher use of formal and informal care services by the moderate and severe dependents groups, regardless of the household income group and time period. Bearing in mind the demographic ageing, our results highlight the need for the identification of potentially vulnerable populations and the efficient planification of long-term care systems and social support services. Full article
(This article belongs to the Special Issue The Economics of Caring)
Article
Socioeconomic and Lifestyle Factors Related to Cost and Frequency of Hospitalization in European Older Adults
Int. J. Environ. Res. Public Health 2021, 18(6), 2833; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18062833 - 10 Mar 2021
Viewed by 717
Abstract
Individuals’ lifestyles play an important role in healthcare costs. A large part of these costs is derived from hospitalizations. With the aim of determine the relationship between lifestyle and the likelihood of hospitalization and associate costs in older adults, this study used the [...] Read more.
Individuals’ lifestyles play an important role in healthcare costs. A large part of these costs is derived from hospitalizations. With the aim of determine the relationship between lifestyle and the likelihood of hospitalization and associate costs in older adults, this study used the Survey of Health, Aging, and Retirement in Europe. Generalized regression models for panel data were developed and adjusted hospitalization costs derived from the length of hospital stay were also estimated. The average adjusted cost of hospitalization was I$ 9901.50 and the analyses showed that performing weekly physical activity significantly reduces the probability of hospitalization (OR: 0.624) and its costs (I$ 2594.5 less per person per year than subjects who never performed physical activity). Muscle strength plays an important role in this relationship and eating habits are not of great significance. Furthermore, we found interesting differences in the frequency and costs of hospitalization between subjects by country. Full article
(This article belongs to the Special Issue The Economics of Caring)
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Article
The Effect of Changes in Cost Sharing on the Consumption of Prescription and Over-the-Counter Medicines in Catalonia
Int. J. Environ. Res. Public Health 2021, 18(5), 2562; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18052562 - 04 Mar 2021
Viewed by 990
Abstract
Many universal health care systems have increased the share of the price of medicines paid by the patient to reduce the cost pressure faced after the Great Recession. This paper assesses the impact of cost-sharing changes on the propensity to consume prescription and [...] Read more.
Many universal health care systems have increased the share of the price of medicines paid by the patient to reduce the cost pressure faced after the Great Recession. This paper assesses the impact of cost-sharing changes on the propensity to consume prescription and over-the-counter medicines in Catalonia, a Spanish autonomous community, affected by three new cost-sharing policies implemented in 2012. We applied a quasi-experimental difference-in-difference method using data from 2010 to 2014. These reforms were heterogeneous across different groups of individuals, so we define three intervention groups: (i) middle-income working population—co-insurance rate changed from 40% to 50%; (ii) low/middle-income pensioners—from free full coverage to 10% co-insurance rate; (iii) unemployed individuals without benefits—from 40% co-insurance rate to free full coverage. Our control group was the low-income working population whose co-insurance rate remained unchanged. We estimated the effects on the overall population as well as on the group with long-term care needs. We evaluated the effect of these changes on the propensity to consume prescription or over-the-counter medicines, and explored the heterogeneity effects across seven therapeutic groups of prescription medicines. Our findings showed that, on average, these changes did not significantly change the propensity to consume prescription or over-the-counter medicines. Nonetheless, we observed that the propensity to consume prescription medicines for mental disorders significantly increased among unemployed without benefits, while the consumption of prescribed mental disorders medicines for low/middle-income pensioners with long-term care needs decreased after becoming no longer free. We conclude that the propensity to consume medicines was not affected by the new cost-sharing policies, except for mental disorders. However, our results do not preclude potential changes in the quantity of medicines individuals consume. Full article
(This article belongs to the Special Issue The Economics of Caring)
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Article
Socioeconomic Factors Related to Job Satisfaction among Formal Care Workers in Nursing Homes for Older Dependent Adults
Int. J. Environ. Res. Public Health 2021, 18(4), 2152; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18042152 - 23 Feb 2021
Viewed by 759
Abstract
Population ageing is increasing the demand for dependent care. Aged care nursing homes are facilities that provide formal care for dependent older persons. Determining the level of job satisfaction among workers in nursing homes and the associated factors is key to enhancing their [...] Read more.
Population ageing is increasing the demand for dependent care. Aged care nursing homes are facilities that provide formal care for dependent older persons. Determining the level of job satisfaction among workers in nursing homes and the associated factors is key to enhancing their well-being and the quality of care. A cross-sectional survey was administered online to nursing home workers (n = 256) in an inland region of Spain over the period from February to May 2017. The questionnaire collected data on sociodemographic variables and others related to training and job satisfaction. The results show that most of the care is delivered by women with a medium level of education. A total of 68% of workers had received formal training, although a significant percentage (65%) thought this was not useful. The highest level of satisfaction was found to be related to users and co-workers. Our factor analysis revealed that the satisfaction components are decision-making, working conditions—e.g., schedule—and the work environment—e.g., relationship with coworkers—. Length of service and working with highly dependent persons are negatively associated with these components. Working in social health care is negatively related to decision-making and working conditions. Training, in contrast, is positively associated with these components. Care is a job that requires appropriate training and preparation to provide quality assistance and to guarantee workers’ well-being. Full article
(This article belongs to the Special Issue The Economics of Caring)
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Article
Quality of Life, Health and the Great Recession in Spain: Why Older People Matter?
Int. J. Environ. Res. Public Health 2021, 18(4), 2028; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18042028 - 19 Feb 2021
Viewed by 789
Abstract
The financial crisis of 2008 precipitated the “Great Recession”. In this scenario, we took Spain as a country of study, because although it experienced significant negative shocks associated with macroeconomic variables (GDP or unemployment), its welfare indicators have been marked by limited changes. [...] Read more.
The financial crisis of 2008 precipitated the “Great Recession”. In this scenario, we took Spain as a country of study, because although it experienced significant negative shocks associated with macroeconomic variables (GDP or unemployment), its welfare indicators have been marked by limited changes. This study used data from waves 2 and 4 (years 2006–2007 and 2010–2012, respectively) of the Survey on Health, Aging and Retirement in Europe (SHARE). Specifically, through logistic regressions we have analysed the effects of socioeconomic, demographic, health and “Great Recession” factors on the quality of life (QoL) of elders in Spain. Although QoL did not change too much during the “Great Recession”, the results confirmed the importance of several factors (such as chronicity) that affect the satisfaction with the QoL among the older people. In this regard, statistically significant effects were obtained for individual exposure to recession. Therefore, a decrease in household income in the crisis period with respect to the pre-crisis period would increase by 44% the probability of reporting a low QoL (OR = 1.44; 95% CI: 1.00–2.07). Furthermore, gender differences were observed. Health and socioeconomic variables are the most significant when determining individual QoL. Therefore, when creating policies, establishing multidisciplinary collaborations is essential. Full article
(This article belongs to the Special Issue The Economics of Caring)
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Article
Catastrophic Household Expenditure Associated with Out-of-Pocket Healthcare Payments in Spain
Int. J. Environ. Res. Public Health 2021, 18(3), 932; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18030932 - 21 Jan 2021
Cited by 1 | Viewed by 1021
Abstract
Background. The financial effect of households’ out-of-pocket payments (OOP) on access and use of health systems has been extensively studied in the literature, especially in emerging or developing countries. However, it has been the subject of little research in European countries, and is [...] Read more.
Background. The financial effect of households’ out-of-pocket payments (OOP) on access and use of health systems has been extensively studied in the literature, especially in emerging or developing countries. However, it has been the subject of little research in European countries, and is almost nonexistent after the financial crisis of 2008. The aim of the work is to analyze the incidence and intensity of financial catastrophism derived from Spanish households’ out-of-pocket payments associated with health care during the period 2008–2015. Methods. The Household Budget Survey was used and catastrophic measures were estimated, classifying the households into those above the threshold of catastrophe versus below. Three ordered logistic regression models and margins effects were estimated. Results. The results reveal that, in 2008, 4.42% of Spanish households dedicated more than 40% of their income to financing out-of-pocket payments in health, with an average annual gap of EUR 259.84 (DE: EUR 2431.55), which in overall terms amounts to EUR 3939.44 million (0.36% of GDP). Conclusion. The findings of this study reveal the existence of catastrophic households resulting from OOP payments associated with health care in Spain and the need to design financial protection policies against the financial risk derived from facing these types of costs. Full article
(This article belongs to the Special Issue The Economics of Caring)
Article
The Burden of Spinal Muscular Atrophy on Informal Caregivers
Int. J. Environ. Res. Public Health 2020, 17(23), 8989; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17238989 - 02 Dec 2020
Cited by 1 | Viewed by 884
Abstract
Spinal muscular atrophy (SMA) is one of the most common severe hereditary diseases of infancy and early childhood. The progression of this illness causes a high degree of disability; hence, a significant burden is experienced by individuals with this disease and their families. [...] Read more.
Spinal muscular atrophy (SMA) is one of the most common severe hereditary diseases of infancy and early childhood. The progression of this illness causes a high degree of disability; hence, a significant burden is experienced by individuals with this disease and their families. We analyzed the time taken to care for patients suffering from SMA in European countries and the burden on their informal caregivers. We designed a cross-sectional study recording data from France, Germany, Spain and the United Kingdom. The primary caregivers completed a self-administered questionnaire that included questions about the time of care, The Zarit Burden Interview, type of SMA and socio-demographic characteristics. Multivariate analyses were used to study the associations between the type of SMA, time of care and burden supported by informal caregivers. The caregivers provided 10.0 h (SD = 6.7) per day of care (the principal caregivers provided 6.9 h, SD = 4.6). The informal caregivers of patients with type I SMA had a 36.3 point higher likelihood (p < 0.05) of providing more than 10 h of care per day in comparison with caregivers of patients with type III SMA. The severity of the disease was associated with more time of care and a higher burden on the caregivers. Full article
(This article belongs to the Special Issue The Economics of Caring)
Article
Visualizing Inequality in Health and Socioeconomic Wellbeing in the EU: Findings from the SHARE Survey
Int. J. Environ. Res. Public Health 2020, 17(21), 7747; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17217747 - 23 Oct 2020
Cited by 2 | Viewed by 771
Abstract
The main objective of this paper is to visualize profiles of older Europeans to better understand differing levels of dependency across Europe. Data comes from wave 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE), carried out in 18 countries [...] Read more.
The main objective of this paper is to visualize profiles of older Europeans to better understand differing levels of dependency across Europe. Data comes from wave 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE), carried out in 18 countries and representing over 124 million aged individuals in Europe. Using the information of around 30 mixed-type variables, we design four composite indices of wellbeing for each respondent: self-perception of health, physical health and nutrition, mental agility, and level of dependency. Next, by implementing the k-prototypes clustering algorithm, profiles are created by combining those indices with a collection of socio-economic and demographic variables about the respondents. Five profiles are established that segment the dataset into the least to the most individuals at risk of health and socio-economic wellbeing. The methodology we propose is wide enough to be extended to other surveys or disciplines. Full article
(This article belongs to the Special Issue The Economics of Caring)
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Article
Assessing the Distribution of Elderly Requiring Care: A Case Study on the Residents in Barcelona and the Impact of COVID-19
Int. J. Environ. Res. Public Health 2020, 17(20), 7486; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17207486 - 15 Oct 2020
Cited by 1 | Viewed by 875
Abstract
In this work, we establish a methodological framework to analyze the care demand for elderly citizens in any area with a large proportion of elderly population, and to find connections to the cumulative incidence of COVID-19. Thanks to this analysis, it is possible [...] Read more.
In this work, we establish a methodological framework to analyze the care demand for elderly citizens in any area with a large proportion of elderly population, and to find connections to the cumulative incidence of COVID-19. Thanks to this analysis, it is possible to detect deficiencies in the public elderly care system, identify the most disadvantaged areas in this sense, and reveal convenient information to improve the system. The methods used in each step of the framework belong to data analytics: choropleth maps, clustering analysis, principal component analysis, or linear regression. We applied this methodology to Barcelona to analyze the distribution of the demand for elderly care services. Thus, we obtained a deeper understanding of how the demand for elderly care is dispersed throughout the city. Considering the characteristics that were likely to impact the demand for homecare in the neighborhoods, we clearly identified five groups of neighborhoods with different profiles and needs. Additionally, we found that the number of cases in each neighborhood was more correlated to the number of elderly people in the neighborhood than it was to the number of beds in assisted living or day care facilities in the neighborhood, despite the negative impact of COVID-19 cases on the reputation of this kind of center. Full article
(This article belongs to the Special Issue The Economics of Caring)
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Article
The Impact of Internet Usage and Knowledge-Intensive Activities on Households’ Healthcare Expenditures
Int. J. Environ. Res. Public Health 2020, 17(12), 4470; https://doi.org/10.3390/ijerph17124470 - 22 Jun 2020
Cited by 3 | Viewed by 759
Abstract
This paper examines the impact of the internet usage and knowledge intensive activities on households’ healthcare expenditures Similarly, the paper aims to recognize and understand, from a value-creation perspective, the correlation between: internet access of households (IA), individuals frequently using the internet (IU), [...] Read more.
This paper examines the impact of the internet usage and knowledge intensive activities on households’ healthcare expenditures Similarly, the paper aims to recognize and understand, from a value-creation perspective, the correlation between: internet access of households (IA), individuals frequently using the internet (IU), individuals searching on internet for health-related information (HI), payments made by households for healthcare (PHH), expressed as euro per inhabitant and employment in knowledge-intensive activities (KIA). The approach utilized in the present study consists of two steps. First, a theoretical framework was conducted to determine the existing relationship between major variables. Next, the Vector Autoregressive (VAR) approach was applied in a case study at European level to prove the three hypothesis we consider. By analyzing the connection between the major variables, a positive and long- lasting impulse response function was revealed, followed by an ascending trend. This suggests that a self-multiplying effect is being generated; and it reasonable to assume that the more individuals use the Internet, the more electronic acquisitions occur. We can thus reasonably conclude that the improvement of the internet usage and knowledge intensive activities on households’ healthcare expenditures process is strongly dependent on people’s capability. Improving IU and KIA is the new reading key in the decision-making process in health system approach. Full article
(This article belongs to the Special Issue The Economics of Caring)
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