Long-Term Care Determinants in Türkiye: Analyzing A Comprehensive Range of Variables

Yıl 2024, Cilt: 24 Sayı: 1, 327 - 346, 28.03.2024

Abdullah Tirgil , Dilruba Vidinel

https://doi.org/10.18037/ausbd.1314563

Öz

By 2050, one in ten people in OECD countries will be 80 aged or older. The aging population will have several impacts on countries, such as increased demand for healthcare and social services, a smaller workforce, and a growing dependency ratio. Türkiye relies heavily on family members to provide long-term care (LTC) for their elderly. In this paper, we study the relationship between a comprehensive range of demographic and socioeconomic variables and informal long-term caregiving using the Turkish Statistical Institute’s Time Use Survey, a nationally representative micro dataset. Employing a multivariate regression analysis, we find that women are more likely to provide unpaid informal caregiving, albeit lacking strong statistical significance. The findings also reveal that being married and older are significant predictors of providing informal LTC. In contrast, we find no significant evidence that income level and house characteristics are crucial determinants of informal LTC. The findings of this study have a number of important policy implications for future practice, such as investing in healthcare and social services and developing policies to encourage LTC workforce participation.

Anahtar Kelimeler

Long Term Care, Multivariate Analysis, Ordinary Least Squares

Türkiye'de Uzun Dönemli Bakım Belirleyicileri: Kapsamlı Bir Değişkenler Dizisinin Analizi

Öz

2050 yılına gelindiğinde OECD ülkelerindeki her on kişiden biri 80 yaş ve üzerinde olacaktır. Yaşlanan nüfusun ülkeler üzerinde sağlık ve sosyal hizmetlere olan talebin artması, işgücünün azalması ve bağımlılık oranının artması gibi çeşitli etkileri olacaktır. Türkiye’de yaşlıların uzun süreli bakımını (USB) sağlamak büyük ölçüde aile üyelerine dayanmaktadır. Bu çalışmada, ulusal düzeyde temsili bir mikro veri seti olan Türkiye İstatistik Kurumunun Zaman Kullanım Anketi'ni kullanarak kapsamlı bir dizi demografik ve sosyoekonomik değişken ile kayıt dışı uzun süreli bakım verme arasındaki ilişkiyi incelemekteyiz. Çok değişkenli bir regresyon analizi kullanarak, kadınların ücretsiz kayıt dışı bakım hizmeti sunma olasılığının daha yüksek olduğu sonucuna ulaştık. Bulgular ayrıca evli ve ileri yaşta olmanın kayıt dışı uzun süreli bakımın önemli belirleyicileri olduğunu ortaya koymaktadır. Buna karşılık, gelir düzeyi ve hane özelliklerinin kayıt dışı uzun süreli bakımın önemli belirleyicileri olduğuna dair anlamlı bir kanıt bulamadık. Bu çalışmanın bulguları, sağlık ve sosyal hizmetlere yatırım yapmak ve işgücüne katılımı teşvik etmek amacıyla politikalar geliştirmek gibi gelecekteki uygulamalar için bir dizi önemli politika çıkarımına sahiptir.

Anahtar Kelimeler

Uzun Süreli Bakım, Çok Değişkenli Analiz, Sıradan En Küçük Kareler Yöntemi

Teşekkür

Türkiye Bilimler Akademisi’ne teşekkür etmek ister.

Kaynakça

• American Association of Retired Persons, National Alliance for Caregiving. (2020). Caregiving in the U.S. 2020. Washington, DC, USA: AARP and National Alliance for Caregiving
• Albuquerque, P. C. (2022). Met or unmet need for long-term care: Formal and informal care in southern Europe. The Journal of the Economics of Ageing, 23, 100409. https://doi.org/10.1016/j.jeoa.2022.100409
• Angrist, J. D. and Pischke, J. S. (2008). Mostly harmless econometrics: An empiricist's companion. Princeton University Press. Retrieved from https://scholar.harvard.edu/yeshen/publications/mostly-harmless-econometrics-empiricists-companion
• Ağören, V. (2017). Bakım sigortasi ve Türkiye için model önerisi. Sosyal Güvence, (12), 1-26. https://doi.org/10.21441/sguz.2017.57
• Ayhan, B. (2014). Uzun süreli bakım sistemleri ve finansman yöntemleri: Türkiye açısından değerlendirmeler in T.C. Aile ve Sosyal Politikalar Bakanlığı Engelli ve Yaşlı Hizmetleri Genel Müdürlüğü (Specialty Thesis). Retrieved from https://www.aile.gov.tr/media/2635/burcu_ayhan.pdf Addati, L., Cattaneo, U. and Pozzon, E. (2022). Care at work: Investing in care leave and services for a more gender equal world of work. Geneva, Switzerland: ILO Publications. Retrieved from: https://www.ilo.org/global/topics/care-economy/WCMS_838653/lang--en/index.htm Brito, E., and Contreras, D. (2023). The Caregiving Penalty: Caring for Sick Parents and the Gender Pay Gap (Unpublished Ph.d. Thesis). Brown University, Providence, Rhode Island, USA.
• Carmichael, F., Charles, S. and Hulme, C. (2010). Who will care? Employment participation and willingness to supply informal care. Journal of health economics, 29(1), 182-190. doi: 10.1016/j.jhealeco.2009.11.003
• Cicirelli, V. G. (1988). A measure of filial anxiety regarding anticipated care of elderly parents. Gerontologist, 28(4), 478-482. https://doi.org/10.1093/geront/28.4.478
• Colombo, F., Llena-Nozal, A., Mercier, J. and Tjadens, F. (2011). Help Wanted? Providing and Paying for Long-Term Care. OECD Health Policy Studies. OECD Publishing. https://doi.org/10.1787/9789264097759-en
• Costa‐font, J., Courbage, C. and Swartz, K. (2015). Financing long‐term care: ex-ante, ex-post, or both?. Health Economics, 24, 45-57. https://doi.org/10.1002/hec.3152
• Gentili, E., Masiero, G, and Mazzonna, F. (2017). The role of culture in long-term care arrangement decisions. Journal of Economic Behavior & Organization, 143, 186-200. doi: 10.1016/j.jebo.2017.09.007
• Geyer, J., Haan, P. and Korfhage, T. (2015). Indirect fiscal effects of long-term care insurance. SSRN Electronic Journal, 38(3), 393-415. https://doi.org/10.2139/ssrn.2706578
• Grigoryeva, A. (2017). Own gender, sibling’s gender, parent’s gender: The division of elderly parent care among adult children. American Sociological Review, 82(1), 116-146. doi: 10.1177/0003122416686521
• Harris-Kojetin, L. D., Sengupta, M., Park-Lee, E. and Valverde, R. (2013). Long-term care services in the United States: 2013 overview. National Center for Health Statistics. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26158640/
• Henz, U. (2009). Couples' provision of informal care for parents and parents-in-law: far from sharing equally?. Ageing & Society, 29(3), 369-395. Retrieved from https://www.cambridge.org/core/ journals/ageing-and-society/article/abs/couples-provision-of-informal-care-for-parents-and-parentsinlaw-far-from-sharing-equally/5798A773A494838BB29448BDA6A7C601
• Informal carers: who take care of them? (2010, April). European centre for social welfare policy and research in Vienna. (Policy Brief). Vienna, Austria: Hoffmann F. and Rodrigues, R.
• Karakuş, B. (2018). Türkiye’de yaşlılara yönelik hizmetler, kurumsal yaşlı bakımı ve kurumsal yaşlı bakımında illerin durumu. Ankara: T.C. Aile ve Sosyal Politikalar Bakanlığı Engelli ve Yaşlı Hizmetleri Genel Müdürlüğü.
• Katz, P. R. (2011). An international perspective on long-term care: focus on nursing homes. Journal of the American Medical Directors Association, 12(7), 487-492. https://doi.org/10.1016/j.jamda.2011.01.017
• Kim, E.-Y. and Kim, C. (2004). Who wants to enter a long-term care facility in a rapidly aging non-western society? attitudes of older koreans toward long-term care facilities. Journal of the American Geriatrics Society, 52(12), 2114–2119. https://doi.org/10.1111/j.1532-5415.2004.52574.x
• Kim, H. B. and Lim, W. (2015). Long-term care insurance, informal care, and medical expenditures. Journal of Public Economics, 125, 128–142. https://doi.org/10.1016/j.jpubeco.2014.12.004
• Mudrazija, S. (2019). Work-related opportunity costs of providing unpaid family care in 2013 and 2050. Health Affairs, 38(6), 1003-1010. https://doi.org/10.1377/hlthaff.2019.00008
• Naiditch, M., Triantafillou, J., Di Santo, P., Carretero, S. and Durrett, E. H. (2013). User perspectives in long-term care and the role of informal carers. Long-term care in Europe: Improving policy and practice, 45-80. Retrieved from https://publications.jrc.ec.europa.eu/repository/handle/JRC78824
• National Research Council. (2010). The role of human factors in home health care: Workshop summary. The National Academies Press. https://doi.org/10.17226/12927
• Navaie-Waliser, M., Spriggs, A. and Feldman, P. H. (2002). Informal caregiving: differential experiences by gender. Medical care, 1249-1259. doi: 10.1097/01.MLR.0000036408.76220.1F
• OECD. (2021). Health at a Glance 2021. OECD Indicators, Paris, France: OECD Publishing. Retrieved from: https://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2021_ae3016b9-en
• Ozbugday, F. C. and Tirgil, A. (2021). The future of long-term care in developing countries: Insights from Turkey. Pablo Villabos Dintrans (Ed.), In The Future of Long-Term Care (p. 25-71). New York: Nova Science Publishers. Retrieved from: https://novapublishers.com/shop/the-future-of-long-term-care/
• Ozbugday, F. C., Tirgil, A. and Kose, E. G. (2020). Efficiency changes in long-term care in OECD countries: A non-parametric Malmquist Index approach. Socioeconomic Planning Sciences, 70, 100733. doi:10.1016/j.seps.2019.100733
• Özmete, E. and Hussein, S. (2017). Türkiye’de yaşlı bakım hizmetleri raporu: Avrupa’dan en iyi uygulama örnekleri ve Türkiye için bir model tasarımı. Ankara: T.C. Aile ve Sosyal Politikalar Bakanlığı.
• Polenick, C. A., Seidel, A. J., Birditt, K. S., Zarit, S. H. and Fingerman, K. L. (2017). Filial obligation and marital satisfaction in middle-aged couples. Gerontologist, 57(3), 417-428. https://doi.org/10.1093/geront/gnv138
• Sakata, K., McKenzie, C. and Kajitani, S. (2022). Informal care and savings. Applied Economics, 54(33), 3762-3776. https://doi.org/10.1080/00036846.2021.1980489
• Silverstein, M., Gans, D. and Yang, F. M. (2006). Intergenerational support to aging parents: The role of norms and needs. Journal of Family Issues, 27(8), 1068-1084. https://doi.org/10.1177/0192513X06288120
• Spann, A., Vicente, J., Allard, C., Hawley, M., Spreeuwenberg, M., and de Witte, L. (2020). Challenges of combining work and unpaid care, and solutions: A scoping review. Health & Social Care in the Community, 28(3), 699-715. doi: 10.1111/hsc.12912
• Stone, R., Cafferata, G. L. and Sangl, J. (1987). Caregivers of the frail elderly: A national profile. The Gerontologist, 27(5), 616-626. https://doi.org/10.1093/geront/27.5.616
• Slobbe, L. C. J., Wong, A., Verheij, R. A., van Oers, H. A. M. and Polder, J. J. (2017). Determinants of first-time utilization of long-term care services in the Netherlands: an observational record linkage study. BMC Health Services Research, 17(1). doi:10.1186/s12913-017-2570-z
• Stein, C. H., Wemmerus, V. A., Ward, M., Gaines, M. E., Freeberg, A. L. and Jewell, T. C. (1998). "Because they're my parents": An intergenerational study of felt obligation and parental caregiving. Journal of Marriage and the Family, 60(3), 611-622. https://doi.org/10.2307/353532
• Stone, R. and Harahan, M. F. (2010). Improving the long-term care workforce serving older adults. Health Affairs, 29(1), 109-115. https://doi.org/10.1377/hlthaff.2009.0554
• Turkish Statistical Institute. (2014-2015). Time use survey microdata set. Retrieved from: https://www.tuik.gov.tr/media/microdata/pdf/zaman-kullanimi-arastirmasi.pdf
• Wolff, J. L., Dy, S. M., Frick, K. D. and Kasper, J. D. (2007). End-of-life care: findings from a national survey of informal caregivers. Archives of Internal Medicine, 167(1), 40-46. https://doi.org/10.1001/archinte.167.1.40
• Wu, B., Cohen, M. A., Cong, Z., Kim, K. and Peng, C. (2021). Improving care for older adults in China: Development of long-term care policy and system. Research on Aging, 43(3-4), 123-126. https://doi.org/10.1177/0164027521990829
• Yang, Z., Norton, E. C. and Stearns, S. C. (2003). Longevity and health care expenditures: the real reasons older people spend more. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 58(1), 2–10. https://doi.org/10.1093/geronb/58.1.S2
• Zarzycki, M., Morrison, V., Bei, E. and Seddon, D. (2023). Cultural and societal motivations for being informal caregivers: A qualitative systematic review and meta-synthesis. Health Psychology Review, 17(2), 247-276. https://doi.org/10.1080/17437199.2022.2032259
• Zhang, L., Zeng, Y., Wang, L. and Fang, Y. (2020). Urban–rural differences in long-term care service status and needs among home-based elderly people in China. International Journal of Environmental Research and Public Health, 17(5), 1701. doi: 10.3390/ijerph17051701
• Zuchandke, A., Reddemann, S., Krummaker, S. and von der Schulenburg, J.-M. G. (2010). Impact of the introduction of the social long-term care insurance in Germany on financial security assessment in case of long-term care need. The Geneva Papers on Risk and Insurance - Issues and Practice, 35(4), 626–643. https://doi.org/10.1057/gpp.2010.26
• Zygouri, I., Cowdell, F., Ploumis, A., Gouva, M. and Mantzoukas, S. (2021). Gendered experiences of providing informal care for older people: a systematic review and thematic synthesis. BMC Health Services Research, 21, 1-15. doi: 10.1186/s12913-021-06736-2