Informal and formal care: Substitutes or complements in care for people with dementia? Empirical evidence for 8 European countries

Patrick Bremer*, David Challis, Ingalill Rahm Hallberg, Helena Leino-Kilpi, Kai Saks, Bruno Vellas, Sandra M. G. Zwakhalen, Dirk Sauerland, RightTimePlaceCare Consortium

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

50 Citations (Web of Science)


Background: In order to contain public health care spending, European countries attempt to promote informal caregiving. However, such a cost reducing strategy will only be successful if informal caregiving is a substitute for formal health care services. We therefore analyze the effect of informal caregiving for people with dementia on the use of several formal health care services.

Study Design: The empirical analysis is based on primary data generated by the EU-project 'RightTimePlaceCare' which is conducted in 8 European countries. 1223 people with dementia receiving informal care at home were included in the study.

Methods: Using a regression framework we analyze the relationship between informal care and three different formal health care services: the receipt of professional home care, the number of nurse visits and the number of outpatient visits.

Results: The relationship between formal and informal care depends on the specific type of formal care analyzed. For example, a higher amount of informal caregiving goes along with a lower demand for home care services and nurse visits but a higher number of outpatient visits.

Conclusion: Increased informal caregiving effectively reduces public health care spending by reducing the amount of formal home care services. However, these effects differ between countries. (C) 2017 Elsevier B.V. All rights reserved.

Original languageEnglish
Pages (from-to)613-622
Number of pages10
JournalHealth Policy
Issue number6
Publication statusPublished - Jun 2017


  • Formal Care
  • Informal Care
  • Dementia
  • Substitute
  • Count Data Model
  • Europe
  • TIME

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