This is the first study to use social insurance data to assess the indirect costs associated with informal caregivers’ short-term absenteeism in Poland. Using the HCM and the societal perspective, the study estimated the economic burden of short-term caregiving in Poland for the 11-year period (2006–2016). The results show that the productivity losses attributable to the provision of short-term care were €306.2 million in 2006 and more than doubled, reaching €824.1 million in 2016. This increase was much higher than of the increase in GDP; the dynamics of the economy’s output grew by 74% in the period investigated, while the indirect costs of absence associated with care increased by 169%. This cost escalation reflects a growing number of caregivers’ absence days throughout the period and was not outweighed by the diminishing duration of the average absence episode.
Notably, the dynamic increase in caregiving incidence and costs observed in Poland cannot be explained by epidemiological patterns or demographic situation as no dramatic changes that could increase absence were observed in these areas. Consider the demography trends of the two groups with potentially the greatest care needs, namely, the young and the elderly populations: although the share of the population aged 65+ years increased by 3% in the period investigated, this rise was accompanied by a drop of similar magnitude (− 2.6%) in the population aged 0–18 years (see Additional file 2 for details). Considering that it was the youngest population that generated the vast majority of the short-term absence, it seems that the overall demographic factors in these two groups do not explain the nearly two-fold increase in the number of absence days. Thus, it is possible that factors other than health or demography may influence the frequency of caregiving; social insurance arrangements or labour market situations could potentially play a role. Of these two, the former remained fairly stable across the period; on the other hand, the labour market situation improved notably, with the unemployment rate dropping from 18% in 2006 to 8.2% in 2016. A more favourable labour market situation for employees could have resulted in a greater inclination to use care allowances because workers were less afraid of job loss. This mechanism has not been investigated in the area of caregivers’ absenteeism; however, previous studies on own absence suggest such a relationship [37,38,39].
Few studies have estimated the indirect costs of informal caregiving, and none of them have used a methodological approach similar to the one adopted here, which accounts for unworked days based on insurance data and is not based on potential economic losses or replacement costs. The American study from 2006 reports that the cost of absenteeism for employers was $7.0 billion, which translated to an equivalent of $441 per employed caregiver [40]; however, according to a recent review, these estimates should be treated with caution because the study makes debatable assumptions in carrying out the analysis [14]. The other research based on 2010 data estimates the cost of caregivers’ absenteeism for the US economy at $25.2 billion [18], or 0.168% of the country’s GDP. On the other hand, the opportunity costs of informal care for elderly Americans in the period 2011–12 amounted to $522 billion annually, while the cost of replacing this care varied from $221 billion to $642 billion depending on whether the care would be delivered by unskilled or skilled workers [41]. A recent Australian study estimates the replacement cost of informal caregiving in 2015 at $60.3 billion, equivalent to 3.8% of GDP [19].
This variation in the estimates of caregiving costs shows that comparability of results from a range of studies is limited because the estimates critically depend on the studies’ settings. The inclusion of such categories as employees’ replacement costs, workday interruptions or unpaid leave in some studies elevates costs compared to the cost reported in studies assessing the impact of absenteeism alone. Moreover, relying on administrative data, as in this study, restricts analysis to the productivity losses associated with absence from formal work and does not allow the inclusion of cost categories that are not routinely reported for formal purposes, such as presenteeism or the value of housekeeping services undone. Additionally, the way productivity losses are valued (opportunity costs vs. market wages or per worker productivity) affects the estimates. For these reasons, the estimates from the present study are hardly comparable with others’ findings. However, the results of the American study, which estimates the costs of absenteeism at $25.2 billion [18], are of similar magnitude in GDP-related terms (0.168% of US’s GDP in 2010) to estimates from this study (0.154% of Polish GDP in the same year).
The results of the present study emphasize complex gender-related disparities in informal care provision. Overall, women lost approximately three times more work days to caregiving than did men. However, this difference was mainly due to the disparity in caring for younger children, while men dominated care for others (adults and older children). The higher incidence of child care among women possibly reflects both an earnings gap between men and women and differences in the distribution of traditional societal roles associated with gender. Because in Poland absence associated with caregiving is subject to a 20% reduction in the employee’s earnings, the economic loss for a family caring for a child is lower when the parent receiving the lower salary provides care. Women in Poland receive 7.2% lower gross hourly earnings than men do (data for 2016) [42] and, for this reason, the cost of care for a household is on average lower when the woman provides care. Additionally, the distribution of traditional social roles attributes more care responsibilities to women [43], and this probably strengthens the gender-related earnings gap effect. On the other hand, though men are those who provide more care days to other family members, a closer inspection of this category shows a more complicated gender-related pattern of caregiving. Short care episodes (1–5 days) are mostly secured by women, while in long-lasting episodes (6 or more days), men dominate caregiving, as shown in the above results (see Additional file 1 for details). It is possible that short episodes are more often those involving older children (aged > 14) in which case women are more likely to deliver care due to the reasons explained above. On the other hand, men’s dominant role in longer care episodes perhaps reflects higher female morbidity and the fact that, in most cases, the only person able to provide care for a sick woman is her husband. In this case, there is usually no choice regarding the person who provides care, and because women are more frequently sick, informal care is provided by their male spouses.
Limitations of the study
This study has the following limitations. Firstly, the estimates only provide evidence on the productivity losses associated with absences that were registered in the social insurance system. Thus, unrecorded care episodes (e.g. provided by those using holiday instead of formal absence) are not included and this fact underestimates the real burden. Secondly, the present study does not show the overall indirect costs of caregiving in Poland; it is limited to short-term absenteeism only, and the burden of long-term or permanent caregiving translating to economic inactivity is not investigated here. Thirdly, economic losses due to housekeeping activities undone and to presenteeism of caregivers are not included because of data unavailability, and this also biases the results downwards. Finally, these estimates do not allow the identification of the costs attributable to particular diseases; the SII does not collect data on diagnoses for caregivers’ absenteeism as it does in own sickness absenteeism, where ICD-10 codes are attributed to each absence episode.