Journal Article

Long-Term Care Financing: Lessons From France

NADASH, PAMELA, RACCO, NATHALIE, DOTY, PAMELA

2015

Overview

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.

• Publisher: Blackwell Publishing Ltd,THE MILBANK MEMORIAL FUND,BlackWell Publishing Ltd
• Subject: Adults / Aged / Aging / Appropriations and expenditures / Benefits / comparative study / Cross-Cultural Comparison / Employee insurance / Employer provided health insurance / Financing, Government / Financing, Personal / France / Health insurance / Humans / Income / Insurance / Insurance coverage / Insurance premiums / Insurance providers / Insurance, Long-Term Care - economics / Insurance, Long-Term Care - legislation & jurisprudence / Local government / long-term care / Long-Term Care - economics / Markets / Medicaid program / Middle Aged / Models, Economic / National health insurance / Older adults / Original Investigations / Partnership / Population aging / Population Dynamics - trends / Presidents / Public-Private Sector Partnerships / Retirement / Sales / Sarkozy, Nicolas / Social insurance / social welfare / United States / Universal Coverage - economics / Universal Coverage - legislation & jurisprudence / Websites