| |
Centre for Policy on Ageing | |
 | |
|
Long-term care financing
— lessons from France | | Author(s) | Pamela Doty, Pamela Nadash, Nathalie Racco |
| Journal title | Milbank Quarterly, vol 93, no 2, 2015 |
| Pages | pp 359-391 |
| Source | http://onlinelibrary.wiley.com/doi/10.1111/1468-00... DOI: 10.1111/1468-0009.12125 |
| Keywords | Long-term care insurance ; Social welfare ; Social policy ; Comparison ; France ; United States of America. |
| Annotation | An ageing 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. The authors 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. They 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. France provides universal public coverage for paid assistance with functional dependency for people aged 60+. 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 centre-right leader, President Nicolas Sarkozy, thereby reducing the prospects of a coordinated public/private strategy. 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 programme. The adequacy of such coverage, however, is a concern. (OFFPRINT.) (RH). |
| Accession Number | CPA-151113005 A |
| Classmark | WPH: TY: TM2: 48: 765: 7T * |
Data © Centre for Policy on Ageing |
|
| ...from the Ageinfo database published by Centre for Policy on Ageing. |
| |
|