Returns to Caring? Health and Wellbeing Effects of Subsidized Long-Term Care

• Authors: Joan Costa-Font, Sergi Jiménez-Martín and Cristina Vilaplana Prieto
• BSE Working Paper: 1593 | September 2026
• Keywords: mental health, Spain, mortality, life satisfaction, long-term care, long-term care subsidies, long-term care supports, old age care, survival, cost per QALY
• JEL codes: I18, J14, J16

We estimate the health and wellbeing effects of subsidized access to long-term care (LTC). Our analysis exploits the staggered implementation of Spain’s 2007 System of Autonomy and Care for Dependent People (SAAD), which expanded publicly funded and universal LTC subsidies and supports, as well as its subsequent reform. Using two decades worth of administrative and survey data and leveraging exogenous regional and individual-level variation in program exposure, we find that access to SAAD benefits reduces the care receiver’s depressive symptoms by about 1 percentage point, increases its survival probability by 2.6–3 percentage points, and raises its life satisfaction by 0.24–0.50 scale points. Cost-effectiveness estimates indicate that the implied cost per quality-adjusted life year (QALY) gained lies below commonly accepted efficiency thresholds for public health spending in Europe. These findings document sizeable health returns and efficiency gains from publicly subsidized LTC provision.