ESR4: A comparison across countries of formal versus informal caregiving and personal preferences in caring for older people now and in the future

Work package 1
ESR Saif Elayyan
Supervisor Prof. Erik Buskens
Co-supervisor Prof. Valerie Morrison
Host institution University Medical Center Groningen, the Netherlands
Contact ESR
Contact supervisor

Objectives: To collect and analyse data on demographics and from formal systems (e.g. actual costs for formal care and existing informal care arrangements) within different countries and to compare to caregivers’ preferences

Apart from the direct financial burden to society, ageing populations will have huge impact on both the formal and the informal economy. Hence, with increasingly constrained budgets and capacity, the key question is what care are we going to provide, by whom and how? An international comparison of formal health care services paid for through taxation or health care insurance will show which need is to be met by informal health care services. The mix of self-care, informal care and formal care is not gratuitous. Depending on the composition of this mix, quality, access and wellbeing may or may not be attained. There may be a considerable difference between what is being offered by formal health care and the wishes, needs and expectations of caregivers and care recipients regarding formal and informal care. Information about discrepancies between what is offered and what is needed within different countries is important input for developing scenarios, that is, projections of the impact of a set of coherent policy measures in terms of cost-effectiveness, satisfaction and quality of care. These scenarios are of crucial importance for policy makers and health care organizations. Information about wishes, needs and expectations of caregivers and care recipients regarding formal and informal care will be collected in the ENTWINE-iCohort study. We will collect data on the various systems in the same countries as in which we will collect the ENWTINE-iCohort data in order to be able to make head to head comparisons between system information and personal preferences. We foresee studying national and regional care provision, and its implications for health care costs and other resources, access and quality through modelling and scenario analyses.

Expected Results

We will be able to present options how to deal with changing circumstances (e.g. budget, ageing) and the willingness to provide care. The results will inform national and international policymakers on the choices ahead, and both wellbeing and financial consequences. In addition, it will give input for businesses to develop assistive technology, which match both the arrangements in the healthcare systems and the willingness to provide care.


Elayan, S., Bei, E., Ferraris, G., Fisher, O., Zarzycki, M., Angelini, V., ... & Morrison, V. (2024). Cohort profile: The ENTWINE iCohort study, a multinational longitudinal web-based study of informal care Plos one, 19(1), e0294106.DOI:

Morrison, V., Zarzycki, M., Vilchinsky, N., Sanderman, R., Lamura, G., Fisher, O., Ferraris, G., Elayan, S., Buskens, E., Bei, E., ... & Hagedoorn, M. (2022). A Multinational Longitudinal Study Incorporating Intensive Methods to Examine Caregiver Experiences in the Context of Chronic Health Conditions: Protocol of the ENTWINE-iCohort. International journal of environmental research and public health, 19(2), 821.


Host Secondment supervisor Aim Duration
Bangor University, the United Kingdom Prof. Valerie Morrison To learn about care policy and assess potential for innovation and intervention using discrete choice models, i.e., optimising across a finite number of alternative set-ups 3 months
The Netherlands Institute for Social Research, the Netherlands Dr. Mirjam de Klerk To learn what research aspects are relevant to trigger changes in governmental policies 3 months