Reforming Long‐Term Care Policy in France: Private–Public Complementarities

Bihan, Blanche Le; Martin, Claude

doi:10.1002/9781444395556.ch3

Cited by 10 publications

(15 citation statements)

References 14 publications

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“…But, as stated in the literature (Ungerson 2005, Ungerson & Yeandle 2007, Da Roit & Le Bihan 2010), the schemes have different characteristics. The French cash payment has three main features (Le Bihan and Martin, 2007, 2010) and is very strictly regulated.…”

Section: Characteristics Of the Cash For Care Scheme: A Strictly Regumentioning

confidence: 99%

“…The French system for caring for older people was traditionally based on home care (Anttonen & Sipila 1996, Jenson 1997) with significant involvement of family members (partners or children) as informal care providers. The system has evolved since the 1990s’ with the development in 1997 of a specific policy for older people, based on a cash for care scheme (Martin 2001, Le Bihan & Martin 2007, 2010, Frinault 2009). Home‐based care is now considered to be a priority, with the dual objective of containing the costs linked to care for older people and satisfying the wish of many older people to continue living at home for as long as possible.…”

Section: Introductionmentioning

confidence: 99%

“…This article investigates the impact of policy measures for older people with care needs on the organisation of home care, by examining the balance between formal and informal care and the redefinition of the initial familialist model. It focuses on the specific cash for care scheme which is at the core of French policy for older people (Le Bihan & Martin 2010). The introduction of this allowance for older people in need of care has blurred the traditional distinction between formal and informal care, with the emergence of new forms of care work.…”

Section: Introductionmentioning

confidence: 99%

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The redefinition of the familialist home care model in France: the complex formalization of care through cash payment

Bihan

2012

Health &Amp; Social Care in the Community

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This article investigates the impact of policy measures on the organisation of home-based care for older people in France, by examining the balance between formal and informal care and the redefinition of the initial familialist model. It focuses on the specific cash for care scheme (the Allocation personnalisée d'autonomie - Personalised allowance for autonomy) which is at the core of the French home-based care policy. The author argues that in a redefined context of 'welfare mix', the French public strategy for supporting home-based care in France is articulated around two major objectives, which can appear contradictory. It aims to formalise a professional care sector, with respect to the employment policy while allowing the development of new forms of informal care, which cannot be considered to be formal employment. The data collection is two-fold. Firstly, a detailed analysis was made of different policy documents and public reports, together with a systematic review of existing studies. Secondly, statistical analysis on home-based care resources were collected, which was not easy, as home-care services for older people in France are part of a larger sector of activity, 'personal services' (services à la personne). The article exposes three main findings. First, it highlights the complexity of the formalisation process related to the introduction of the French care allowance and demonstrates that formalisation, which facilitates the recognition of care as work, does not necessarily mean professionalisation. Second, it outlines the diversity of the resources available: heterogeneous professional care, semi-formal forms of care work with the possibility to employ a relative and informal family care. Finally, the analysis outlines the importance of the regulation of cash payments on the reshaping of formal and informal care and comments on its impact on the redefinition of informal caring activities.

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Section: Characteristics Of the Cash For Care Scheme: A Strictly Regumentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The redefinition of the familialist home care model in France: the complex formalization of care through cash payment

Bihan

2012

Health &Amp; Social Care in the Community

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“…Our description shows that even with supplementary private insurance, the French receive a fairly bare‐bones level of coverage. Le Bihan and Martin estimated that dependency costs average €2,500 ($3,400) per month (€3,500 [$4,760] in cases of “severe” dependency). They compared this with an average payout of €500 ($680) from the APA and €300 ($408) from private LTCI.…”

Section: Introductionmentioning

confidence: 99%

Long‐Term Care Financing: Lessons From France

2015

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Policy Points: France's model of third‐party coverage for long‐term services and supports (LTSS) combines a steeply income‐adjusted universal public program for people 60 or older with voluntary supplemental private insurance. French and US policies differ: the former pay cash; premiums are lower; and take‐up rates are higher, in part because employer sponsorship, with and without subsidization, is more common—but also because coverage targets higher levels of need and pays a smaller proportion of costs. Such inexpensive, bare‐bones private coverage, especially if marketed as a supplement to a limited public benefit, would be more affordable to those Americans currently most at risk of “spending down” to Medicaid. Context An aging population leads to a growing demand for long‐term services and supports (LTSS). In 2002, France introduced universal, income‐adjusted, public long‐term care coverage for adults 60 and older, whereas the United States funds means‐tested benefits only. Both countries have private long‐term care insurance (LTCI) markets: American policies create alternatives to out‐of‐pocket spending and protect purchasers from relying on Medicaid. Sales, however, have stagnated, and the market's viability is uncertain. In France, private LTCI supplements public coverage, and sales are growing, although its potential to alleviate the long‐term care financing problem is unclear. We explore whether France's very different approach to structuring public and private financing for long‐term care could inform the United States’ long‐term care financing reform efforts. Methods We consulted insurance experts and conducted a detailed review of public reports, academic studies, and other documents to understand the public and private LTCI systems in France, their advantages and disadvantages, and the factors affecting their development. Findings France provides universal public coverage for paid assistance with functional dependency for people 60 and older. Benefits are steeply income adjusted and amounts are low. Nevertheless, expenditures have exceeded projections, burdening local governments. Private supplemental insurance covers 11% of French, mostly middle‐income adults (versus 3% of Americans 18 and older). Whether policyholders will maintain employer‐sponsored coverage after retirement is not known. The government's interest in pursuing an explicit public/private partnership has waned under President François Hollande, a centrist socialist, in contrast to the previous center‐right leader, President Nicolas Sarkozy, thereby reducing the prospects of a coordinated public/private strategy. Conclusions American private insurers are showing increasing interest in long‐term care financing approaches that combine public and private elements. The French example shows how a simple, cheap, cash‐based product can gain traction among middle‐income individuals when offered by employers and combined with a steeply income‐adjusted universal public program. The adequacy of such coverage, however, is a concern.

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“…Notable cases include Japan, where about 23 percent of the population is currently 65 or older (Central Intelligence Agency, 2011a); Germany, which has a 16‐year history of public LTCI; and Sweden, which spends the most on LTC – and has the highest proportion of persons over 60 years of age in the EU (Organization for Economic Co‐operation and Development, 2005). Coverage is rarely comprehensive: benefits may be income related, as in France (Le Bihan & Martin, 2010) where a substantial market for private LTCI has evolved, or the system may not fully cover the cost of care, as in Germany (Rothgang, 2010). In practice, of course, all systems of LTC are heavily subsidized by the unpaid labor of informal caregivers (mostly female family members), which comprise most LTC.…”

Section: Introductionmentioning

confidence: 99%

Introducing social insurance for long‐term care in Taiwan: Key issues

Nadash

Shih

2012

Int J Soc Welfare

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Nadash P, Shih Y.-C. Introducing social insurance for longterm care in Taiwan: Key issues Taiwan will shortly complete its comprehensive social safety net, which includes national health insurance, retirement security, and unemployment insurance, by introducing long-term care (LTC) insurance -putting it ahead of the many countries that rely on a patchwork of policies to address the need for LTC. The program, to be implemented in 3 to 5 years, will cover all citizens on a primarily social insurance basis. The range of LTC policy options considered is discussed, particularly how to structure the program, how to finance and regulate it, and how to develop its inadequate LTC infrastructure and workforce. Particularly thorny issues include the choice of social insurance, the feasibility of cash benefits, and how to address Taiwan's heavy reliance on foreign workers. Taiwan's increasingly democratic character, along with high levels of public support for the program, creates significant pressure on politicians to deliver on their promises to implement LTC reform.Key Practitioner Message: • Emphasizes the importance of policy learning from other environments; • Highlights the need for a strong regulatory and provider infrastructure for delivering long-term care services; • Emphasizes the need for training, support, and appropriate regulation of the long-term care workforce.

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Reforming Long‐Term Care Policy in France: Private–Public Complementarities

Cited by 10 publications

References 14 publications

The redefinition of the familialist home care model in France: the complex formalization of care through cash payment

The redefinition of the familialist home care model in France: the complex formalization of care through cash payment

Long‐Term Care Financing: Lessons From France

Introducing social insurance for long‐term care in Taiwan: Key issues

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