The causal effects of caregiving on the spousal carer's health, life satisfaction, and employment

照顾对配偶照顾者的健康、生活满意度和就业的因果影响

• 批准号: ES/Y010337/1
• 负责人: Haiyu Jin
• 金额: $ 13.8万
• 依托单位: University of Southampton
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2023
• 资助国家: 英国
• 起止时间: 2023 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=ES%2FY010337%2F1
• 关键词: causal; effects; caregiving; spousal; carer

In light of the development of the Long-term Care Insurance Policy in China, an emerging issue of concern is whether to compensate the families of those who need long-term care and who are cared for by family carers, and if so, by how much. It is therefore important and urgent to understand the effects of caregiving on the family carer's health and life satisfaction, as well as the financial costs of family caregiving. Despite expanding research investigating the association between caregiving and the family carer's health and life satisfaction, both internationally and within the specific context of China, a consistent conclusion has not been reached, potentially because of the existence of endogeneity (which refers to a problem that an independent variable [x] is correlated with the error term [e] in a regression model) related to the family effects (i.e. having a family member in poor health may directly affect an individual's health) and selection effects (i.e. individuals who are healthier are more likely to provide care). Furthermore, little is known about the effects of caregiving on older spousal carers' employment or work hours. Consequently, my research aimed to examine the causal effects of caregiving on older spousal carers' health, life satisfaction, work participation, and work hours in China. My research expanded our understanding of the source of endogeneity in the relationship between caregiving and the spousal carer's health and life satisfaction, and further developed the use of a fixed effects triple difference model in order to address endogeneity related to family effects and selection effects.Based on two separate empirical analyses, using data from waves 2015 and 2018 of the China Health and Retirement Longitudinal Study, my research found that:(1) Individuals aged 60+ years who were willing and able to provide care to their spouse had better health than those who were unwilling or unable to provide care, after controlling for the caregiving status and other variables (the family effects, demographic, and socioeconomic characteristics) in the model. This evidence indicates the existence of selection effects. (2) Individuals aged 60+ years whose spouse reported needing care had worse health than those whose spouse did not report needing care, after controlling for the caregiving status and other variables (the family effects, demographic, and socioeconomic characteristics) in the model. This evidence shows the existence of family effects.(3) Female carers aged 60+ years were less likely to report difficulties in performing instrumental activities of daily living than female non-carers. Furthermore, female carers were more likely to report poor self-reported health than female non-carers, controlling for the family effects, selection effects, demographic, and socioeconomic characteristics in the model.(4) Male carers aged 60+ years were 15.4% less likely to be in paid employment than male non-carers.These results have important policy implications, particularly with the intersecting policy agendas of encouraging individuals to work for longer in the context of increasing longevity (i.e. extending working life agenda), and supporting informal carers to continue providing care to their spouses. The results suggest that policy makers need to pay more attention to older spousal carers' health and seek ways to delay the onset of those older carers' own need for long-term care. Moreover, although stopping work may be associated with an individual's personal motivation to provide care, the results of the empirical analysis support the provision of financial compensation to family carers in order to replace the wages forgone by those who cease paid employment in order to take up unpaid family care responsibilities.

鉴于中国长期护理保险政策的发展，一个值得关注的新问题是，是否对那些需要长期护理和由家庭照顾者照顾的人的家庭进行赔偿，如果是，赔偿多少。因此，了解照顾对家庭照顾者的健康和生活满意度的影响以及家庭照顾的经济成本是重要和紧迫的。尽管越来越多的研究调查了护理与家庭照顾者的健康和生活满意度之间的关系，无论是在国际上还是在中国的特定背景下，都没有得出一致的结论。可能是因为存在内生性（指回归模型中自变量[x]与误差项[e]相关的问题），这与家庭效应（即家庭成员健康状况不佳可能直接影响个人的健康）和选择效应（即更健康的个人更有可能提供护理）有关。此外，关于照顾对老年配偶照顾者的就业或工作时间的影响知之甚少。因此，我的研究旨在检验照顾对中国老年配偶照顾者的健康、生活满意度、工作参与和工作时间的因果影响。我的研究扩展了我们对照顾与配偶照顾者健康和生活满意度之间关系的内生性来源的理解，并进一步发展了使用固定效应三差模型来解决与家庭效应和选择效应相关的内生性。基于2015年和2018年中国健康与退休纵向研究的数据，我的研究发现：(1)在模型中控制了照顾状态和其他变量（家庭效应、人口统计学和社会经济特征）后，愿意和能够照顾配偶的60岁以上个体比不愿意或不能照顾配偶的个体健康状况更好。这一证据表明选择效应的存在。(2)在模型中控制了照顾状况和其他变量（家庭效应、人口统计学和社会经济特征）后，配偶报告需要照顾的60岁以上老年人的健康状况比配偶没有报告需要照顾的人差。这一证据表明家庭效应的存在。(3) 60岁以上的女性照护者较非照护者报告在日常生活中进行工具性活动的困难较少。此外，在控制了模型中的家庭效应、选择效应、人口统计学和社会经济特征后，女性照顾者比非照顾者更有可能报告自我报告的健康状况不佳。(4) 60岁以上男性照顾者从事有薪工作的可能性比非照顾者低15.4%。这些结果具有重要的政策意义，特别是在鼓励个人在延长寿命的背景下延长工作时间（即延长工作寿命议程）和支持非正式照顾者继续为其配偶提供照顾的交叉政策议程方面。结果表明，政策制定者需要更多地关注老年配偶照顾者的健康，并寻求方法来推迟老年照顾者自己对长期照顾的需求。此外，虽然停止工作可能与个人提供照顾的个人动机有关，但实证分析的结果支持向家庭照顾者提供经济补偿，以取代那些停止有偿就业以承担无偿家庭照顾责任的人所放弃的工资。