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

Abstract

We argue that the long-term care (LTC) policy reform in France results from a long-lasting evolution process that began in the 1980s and has led to the so-called 'French compromise'. This combines elements of different types of a fragmented care system including health insurance schemes, domiciliary and residential social care providers, tax deductions and an important private insurance sector, not to mention the crucial contribution of informal caregivers in families. This article concentrates on policies in both the public and the private sectors, as well as their overall cost. We focus on the core of the LTC policy, namely the creation and then the reforms of the cash-for-care allowance (Allocation personnalisée à l'autonomie). The evolution of the policy process concluded, after the 2007 Presidential election, with the announcement of a new direction, which has not been implemented yet, but which has raised professional and social concerns. Evidence from France suggests that LTC reform can only take place from a new compromise between three poles of protection: the family, the market and the state. A Fragmented PolicyConfronted by the ageing of its population, France has, over the last few decades, developed a specific LTC policy for the elderly. The objective is to complement the informal care provided by relatives (mainly women), which still represents the main contribution to the provision of the care needs of the elderly. The LTC system does not constitute a homogeneous policy field. It cuts across a range of policies in the public sector such as social care, health

The turn to optional familialism through the market: Long‐term care, cash‐for‐care, and caregiving policies in Europe

“…However, simultaneously to these policy measures reinforcing the initial logic of DP, the economic crisis led the to the introduction of explicit austerity measures, which have entailed significant spending cuts at the local level and made it difficult to implement fully the different objectives of personalization (Glendinning, 2017). In France and Germany, the CfC schemes have been confirmed as the main pillar of the LTC policies (Le Bihan & Martin, 2010;Mätzke & Wib, 2017) with adjustments strengthening the scheme (increase of the amount of the benefit in both countries and inclusion of people suffering from dementia in Germany). In Germany, expansion goes along with a significant financial investment in the scheme in order to regulate the cost of social assistance at the municipality's level.…”

Sustainability of Long-term Care: Puzzling Tasks Ahead for Policy-Makers

“…French people with pre-existing conditions are often exempted from insurance. 16,21 In 2001, the growth rate in the number of insurance contracts in France reached 22%, mainly because insurers started marketing or cross-selling their products. The growth rate declined in 2006, after the French Government announced its intention to reform LTC insurance.…”

Building ‘implicit partnerships’? Financial long-term care entitlements in Europe

“…In both systems, the cash payments can be used to fund continuous, informal caregiving, as well as one-off payments, for example, for training. Cash for care (CfC) was instituted in France in 2002 through the APA; however with strict restrictions on how the cash benefit is spent (Le Bihan and Martin 2010;Doty et al 2015), they were only reduced in 2003 and increased in 2015 (Da Roit and Le Bihan 2019). In Sweden, cash payments play a smaller role and are generally focused on young, disabled citizens rather than the elderly with care needs (Sundström et al 2002).…”