Informal Caregiving: Health System Cost Implications
Open accessAbstract
BACKGROUND: Informal caregiving is seen as a low-cost substitute for care provided by health care professionals. However, caregiving is known to negatively impact caregivers' health and, subsequently, their health care use and costs. This could potentially offset the caregivers' contributions to the health care system. OBJECTIVE: We examined the impact of caregiving on costs associated with caregivers' use of publicly funded health care services in Ontario, Canada, in comparison with non-caregivers. METHODS: We included Ontarians who participated in the Canadian Community Health Survey-Healthy Aging Supplement Survey of 2008/09 and linked responses to health care administrative databases. A difference-in-differences design was used to capture differences in caregivers' and non-caregivers' total health care costs 1 and 2 years before and after caregiving start date. Generalized Linear Models were used to model the total health care costs. RESULTS: The sample size was 4275 with 1265 caregivers and 3010 non-caregivers. We found that while health care utilization increased over time, it increased by a lesser amount for caregivers than non-caregivers. Adjusted total health care costs for caregivers were 11.32% (SE = 0.05, ρ = 0.02) lower than non-caregivers 2 years into caregiving. CONCLUSIONS: Our study reveals a critical gap in policy, practice, and research driven by a lack of routine data collection and caregiver identification. It also highlights the need for additional longitudinal research focusing on caregivers' objective health.
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Family caregivers provide the majority of care in homes and communities.
“caregivers provide the majority of care in homes and communities, support system navigation, and maintain continuity of care, often bridging the gaps left by fragmented service delivery models [2,3,4].”
From Home care comparison (2026) · cites this paper as [3]
The introductory passage following the Abstract’s Conclusions says that unpaid caregivers provide care to family and others, and that reliance on them is growing as care shifts to homes and communities. It does not establish that family caregivers provide the majority of care in those settings. (LLM, conf=0.85)
Experimental — accuracy not yet measuredFamily caregivers support system navigation.
“caregivers provide the majority of care in homes and communities, support system navigation, and maintain continuity of care, often bridging the gaps left by fragmented service delivery models [2,3,4].”
From Home care comparison (2026) · cites this paper as [3]
The Discussion describes caregivers as delivering care and calls for better assessment and support of them, but it does not say they help families navigate the health system. Searches for navigation, care coordination, appointments, and access to services found no passage addressing that role. (LLM, conf=0.72)
Experimental — accuracy not yet measuredFamily caregivers maintain continuity of care, often bridging gaps left by fragmented service delivery models.
“caregivers provide the majority of care in homes and communities, support system navigation, and maintain continuity of care, often bridging the gaps left by fragmented service delivery models [2,3,4].”
From Home care comparison (2026) · cites this paper as [3]
The Introduction describes growing reliance on informal caregivers for home and community care, but does not say they maintain continuity of care or bridge fragmented services. The Methods uses a continuity-of-care measure for access to physician services, not for caregivers’ role. Searches for fragmented service delivery and caregivers’ care coordination found no passage establishing the attributed claim. (LLM, conf=0.72)
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Self-citation
- Authors
- Shearkhani, S., Bai, Y. Q., Kuluski, K., Anderson, G. M., & Wodchis, W. P.
- Affiliations
- University of Toronto (CA)
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Corresponding author
- Shearkhani, Sara
- Venue
- Western Journal of Nursing Research
- Publisher
- SAGE Publications
- Published
- 2024-12-31
- Volume
- 47
- Issue
- 3
- Pages
- 140-148
- ISSN
- 0193-9459 (ISSN-L)
- 1552-8456
- PMC
- PMC11812279
- OpenAlex
- W4405921161
- Cited by
- 6
- References
- 41
- Citations by year
- 2026: 4 · 2025: 2
- FWCI
- 4.10
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Western Journal of Nursing Research (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- Health System Performance Network
- Canadian Frailty Network
- Topics
- Health Sciences › Health Professions › Pharmacy › Nursing care and research
- Social Sciences › Sociology and Political Science › Intergenerational Family Dynamics and Caregiving
- Health Sciences › Health Professions › General Health Professions › Aging, Elder Care, and Social Issues
- Keywords
- informal care, caregiver health, health care costs, health care utilization, publicly funded health services, caregiver identification, caregiver burden, Ontario
- MeSH terms
- Aged, Female, Humans, Male, Middle Aged, Ontario, Surveys and Questionnaires, Caregivers, Health Care Costs
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