Pay less, consume more? The price elasticity of home care for the disabled elderly in France

Roquebert, Quitterie; Tenand, Marianne

doi:10.1002/hec.3531

Cited by 29 publications

(25 citation statements)

References 32 publications

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“…They show that an exogenous increase in formal care use is associated with lower informal care use. Although their study population differs from ours, 28 the findings of the two studies are consistent and indicate that the decrease is concentrated at the extensive margin of informal care. Arnault [1], using the same data, avoids the assumptions of the IV hypothesis and estimates a reducedform model identifying the cross-price elasticity of formal and informal care volumes.…”

Section: Discussionsupporting

confidence: 74%

“…This may be because even when disability status is controlled for, income is associated with unobserved dimensions of health, such that low income reflects higher care needs. 8 Several papers dealing with the price sensitivity of formal care demand have shown that demand is sensitive to the price at the intensive margin [26,28]. At the extensive margin, results are less convincing.…”

Section: Sample Selectionmentioning

confidence: 99%

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Does the amount of formal care affect informal care? Evidence among over-60s in France

Perdrix

Roquebert

2021

Eur J Health Econ

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This paper investigates the causal effect of the amount of formal care used on the informal care received by formal care users. We use an original instrument for formal care volume based on local disparities (NUTS 3 level, 96 units) in the price of formal care. Using the French CARE survey, we use a two-part model to assess the effect of formal care on the extensive and the intensive margin of informal care. An increase in the amount of formal care is found to be associated with a small decrease in the probability of using informal care. Heterogeneity tests show that this negative effect is mainly driven by help for daily activities provided by women. At the intensive margin, informal care is not significantly affected by the amount of formal care. Reforms increasing subsidies for formal care can thus be suspected to have a limited effect on informal care arrangements.

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Section: Discussionsupporting

confidence: 74%

Section: Sample Selectionmentioning

confidence: 99%

Does the amount of formal care affect informal care? Evidence among over-60s in France

Perdrix

Roquebert

2021

Eur J Health Econ

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“…Some papers have found the elderly do not adjust their use of nursing home care to its out-of-pocket price (e.g., Grabowski & Gruber, 2007), whereas others have found nonzero price elasticities (e.g., Reschovsky, 1998;Hackmann & Pohl, 2018). Home care use has been shown to be moderately price elastic in Europe (Roquebert & Tenand, 2017). Besides concerns about the validity of the available estimates in the Dutch context, the lack of evidence on the cross-price elasticity of home care and institutional care as well as the complexity of the Dutch co-payment schedule make it difficult if not impossible to predict the extent to which copayments may account for the pro-poor concentration of LTC use that we observe.…”

Section: Robustness Of the Resultsmentioning

confidence: 99%

Equal long‐term care for equal needs with universal and comprehensive coverage? An assessment using Dutch administrative data

2020

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The Netherlands is one of the few countries that offer generous universal public coverage of long‐term care (LTC). Does this ensure that the Dutch elderly with similar care needs receive similar LTC, irrespective of their income? In contrast with previous studies of inequity in care use that relied on a statistically derived variable of needs, our paper exploits a readily available, administrative measure of LTC needs stemming from the eligibility assessment organized by the Dutch LTC assessment agency. Using exhaustive administrative register data on 616,934 individuals aged 60 and older eligible for public LTC, we find a substantial pro‐poor concentration of LTC use that is only partially explained by poorer individuals' greater needs. Among those eligible for institutional care, higher‐income individuals are more likely to use—less costly—home care. This pattern may be explained by differences in preferences, but also by their higher copayments for nursing homes and by greater feasibility of home‐based LTC arrangements for richer elderly. At face value, our findings suggest that the Dutch LTC insurance “overshoots” its target to ensure that LTC is accessible to poorer elderly. Yet, the implications depend on the origins of the difference and one's normative stance.

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“…Assuming no supply constraints, the negative income gradient in home care use would likely be caused by differences in individuals' choices. One such explanation might be a nonzero price elasticity of home care demand (Non, 2017;Roquebert & Tenand, 2017), as the copayment schedule translates into a marginal price of home care 21 Recall that the survey was conducted in the Fall 2012. 22 We have checked that our main result-of a negative gradient in home care use, conditional on needs, and entitlements-is robust to assuming that all vouchers are used to compensate informal with imputed value set to 0.…”

Section: Discussionmentioning

confidence: 99%

Eligibility or use? Disentangling the sources of horizontal inequity in home care receipt in the Netherlands

2020

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We study horizontal inequity in home care use in the Netherlands, where a social insurance scheme aims to allocate long‐term care according to care needs. Whether the system reaches its goal depends not only on whether eligible individuals have equal access to care but also on whether entitlements for care reflect needs, irrespective of socioeconomic status and other characteristics. We assess and decompose total inequity into inequity in (i) entitlements for home care and (ii) the conversion of these entitlements into actual use. This distinction is original and important, because inequity calls for different policy responses depending on the stage at which it arises. Linking survey and administrative data on the 65 and older, we find higher income elderly to receive less home care than poorer elderly with similar needs. Although lower income elderly tend to make greater use of their entitlements, need‐standardized entitlements are similar across income, education, and wealth levels. However, both use and entitlements vary by origin and place of residence. The Dutch need assessment seems effective at restricting socioeconomic inequity in home care use but may not fully prevent inequity along other dimensions. Low financial barriers and universal eligibility rules may help achieve equity in access but are not sufficient conditions.

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Pay less, consume more? The price elasticity of home care for the disabled elderly in France

Cited by 29 publications

References 32 publications

Does the amount of formal care affect informal care? Evidence among over-60s in France

Does the amount of formal care affect informal care? Evidence among over-60s in France

Equal long‐term care for equal needs with universal and comprehensive coverage? An assessment using Dutch administrative data

Eligibility or use? Disentangling the sources of horizontal inequity in home care receipt in the Netherlands

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