H. Patient Incurred Cost
3. How do I estimate the value of caregiver time?
VA patients frequently receive some form of care from unpaid caregivers, typically family members. These services have an economic value that should be measured when determining the total cost of care.
The only way to learn about caregiver time is through direct measurement. Caregivers can be surveyed in person, by telephone, or by mail. If caregiving is likely to last over many weeks, if possible it is advisable to supply caregivers with activity logs to fill out. The goal is to determine the total time spent on the patient due to the condition under study. This includes time spent providing care, time spent on the person's behalf, and time spent accompanying the patient to medical appointments. In some cases the condition of interest may not necessitate any extra time above and beyond what the patient would have received absent the condition. In that case there would be no extra (or incremental) cost due to this condition.
The next step is to assign a value to caregivers' time. If the person is employed, a reasonable measure is his or her hourly wage. This information can be requested on a survey or in person. To find hourly earnings, divide the annual earnings by 2088 for full-time workers. For part-time workers, multiply the average hours per week times the number of weeks worked per year to determine the hours worked per year, and then divide total earnings by that amount.
If the caregiver is not employed or refuses to divulge earnings information, it will be necessary to find another reasonable value. Much unpaid caregiving consists of household chores, light medical procedures, and accompanying patients to medical appointments. One option is to assign the average cost of a home health aide. TheU.S. Bureau of Labor Statistics (BLS) develops monthly statistics on average wages for hundreds of occupation classes. "Home health care services," job class 6216, had an average hourly pay rate of $15.17 per hour in November, 2006. (For data on other months, visit the BLS web site, scroll down to Tables from Employment and Earnings, and look for "B-16. Average hours and earnings of production and nonsupervisory works on private nonfarm payrolls by detailed industry.") Although local or regional wages would be more accurate for a specific locale, using a national average will increase the external validity of the result. In sum, to determine the value of unpaid caregivers' time, you will need to collect the following information:
- Number of hours spent giving care beyond what would occur in the absence of the condition under study.
- If employed, one of these: a) hourly earnings rate; b) for full-time workers, total annual earnings; c) for part-time workers, total hours worked per year (or month, or week) and total dollars earned for the same time period.
As with any direct measurement procedure, it is good practice to carry out sensitivity analyses. Try changing the wage rate used, for example, and see how much your final result changes. When reporting results, include a statement about the sensitivity.