FONTAINE Romeo

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Organized around the principle of subsidiarity, the eligibility and the amount of many social benefits are conditioned on the current resources of the applicant, but also on the value - or even the composition - of his or her assets and the expected contribution of his or her family group. However, the assessment of the contributory capacity of the applicant and his/her relatives varies significantly from one benefit to another. In the case of ASH, the principle of subsidiarity is still widely applied. Various scenarios for relaxation or adjustment are presented here, based on the work carried out by the HCFEA.

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It is often argued that the increased labor market participation of seniors threatens family support provided to dependent elderly people. The purpose of this paper is to assess the causal effect of retirement on the frequency of care provided by individuals aged 55–69 years to their elderly parent. Using data from the Survey of Health, Aging and Retirement in Europe (SHARE), we estimate an endogenous switching model that allows the retirement effect to be heterogeneous with respect to observed and unobserved characteristics. To tackle the possible endogeneity of selection into retirement, we use the heterogeneity of retirement rules between and within European countries. On average, being retired does not significantly impact the probability of providing care but significantly increases the frequency of care conditional on being caregiver. The same pattern is observed regardless of the individual observed characteristics, even if the provision of informal care appears to be less sensitive to the retirement status when the child cannot rely on the other parent to provide care or when both parents are in poor health. These results suggest that pension system reforms should not affect the number of caregivers. Some adverse effects on the intensity of involvement among caregivers are nevertheless expected.

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This article provides an overview of the organization of the financing of assistance to dependent elderly people in France. It restores the principles that have governed, since 1996, the construction of national public solidarity for the financing of independent living assistance, based on the historical foundation of social assistance, and analyzes, beyond theoretical principles, the actual global consequences of their implementation through a tangle of more or less coherent systems. Finally, it puts forward some recommendations for improving the economic efficiency and equity of public action in the field of autonomy support. At a time when the Covid-19 epidemic has just focused the media spotlight on collective accommodation facilities for dependent elderly people (EHPAD), we feel it is particularly important to guide, without sentimentality or haste, the reflection on the investments that the community is ready to make for the care and safety of dependent elderly people.

The population of most countries is aging and the main caregivers are children. Policy makers are also promoting the provision of care by relatives to delay institutionalization of the elderly. We study the provision of care by children, how assistance is distributed among them, and its effectiveness in delaying institutionalization of the elderly. The main contributions can be summarized as follows. Retirement policies can have negative consequences for frail people with a high number of assistance needs who require daily attention. Children do not coordinate when deciding what to provide for their parent, and the allocation of the help they provide is then inefficient. The results suggest that children are strategic substitutes, but also that the strategic effect is greater for a sister than a brother. This can be explained theoretically by greater productivity in helping women than men. Policy makers should expect that stimulating informal care may accelerate the admission of elderly people with poor health.

What role do caregivers play in accompanying and supporting people with disabilities?

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The economic literature extensively outlines a future decline in family support for the disabled elderly. However, the existing literature overlooks the existence of contextual interactions in the family, ignoring that factors reducing the caregiving supply from some potential caregivers may simultaneously increase the propensity of others becoming involved in caregiving, through an intrafamily offset mechanism. Thus, contextual interactions are likely to moderate the impact of changes in the family network on filial caregiving. Using French cross-sectional data from the 2008 Disability and Health Survey, our empirical analysis confirms the importance of considering contextual interactions when investigating filial caregiving: children become involved in care more often when they have fewer siblings, when siblings participate in the labour market or when they live far away from the parent. Gender differences in contextual interactions also indicate that changes in the family network are likely to reduce the existing gender inequalities in filial caregiving.

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Based on the Handicap-Santé survey, Household component (INSEE-Drees, 2008), we study the configurations of family assistance around an elderly and dependent parent in France. A first descriptive step shows that the assistance provided by children is affected by the parent's marital status, the size of the siblings and the rank in the siblings. The analysis then focuses on two-child families and shows that the differences in mobilization observed according to rank stem from three sources: differences in individual characteristics between older and younger siblings, the different impact of these characteristics on the decision to help, and finally a difference in the adjustment of one to the behavior of the other (endogenous interactions). The impact of family characteristics appears to be relatively similar for older and younger people - in particular the strong assignment of women with a brother to the role of caregiver - but the behaviour of younger people also reveals a trade-off between the costs and benefits of assistance. With a definition of help focused on the tasks of daily living, only one major explanation for the differences remains: asymmetry in adjustment to the other child's behavior, given individual and family characteristics.

As the population ages, the question of caring for dependent older adults is becoming a major issue for society. The French government has introduced policies on the issue, but family and children provide much of the care themselves. When a person becomes dependent, does the number and gender distribution of their children have an impact on the care they receive? It is known that the majority of caregivers are women, but what happens with single-sex sibships? Do older and younger siblings behave differently? Taking data from the Handicap-Santé survey on disability and health, Quitterie Roquebert, Romeo Fontaine and Agnès Gramain highlight asymmetries of both gender and birth order in the care children give their parents, with differences according to the type of help provided.

The law on adapting society to aging (ASV law), passed on December 28, 2015, includes a reform of the personalized autonomy allowance (APA) for dependent people living at home. Through several measures, this reform aims to reduce, for the most dependent beneficiaries, their financial participation in home assistance expenses. One of these measures provides for an increase in the amount of the legal ceilings, i.e. the maximum amount of expenses that can be financed by the APA. The impact of this measure on the amount of home help subsidized by the APA is difficult to anticipate. It depends on the answer to two questions. To what extent did the assistance plans run up against the legal ceilings? How much of the home help was consumed beyond the assistance plans? Using data on the clients of a home care service (SAAD), this note puts into perspective the mechanism of action of the legal ceilings by analyzing the differences between the quantity of aid consumed by the clients of the service, the level of the aid plans prescribed to them and that of the ceilings set by the legislator.

This thesis aims to highlight the determinants of medical innovation and its effects on economic growth. It is based on the construction of a database of expenditures and consumption of health goods and services between 1980 and 2010, as well as on three theoretical models. The results, for cohorts born between 1923 and 2010, show that medical innovations are essentially determined by demographic variations. Moreover, even if these medical innovations have historically allowed the emergence of important economies of scale, they do not currently play a driving role in macroeconomic growth. Indeed, under the current conditions of stable survival curves, the mechanics of medical innovation do not appear to be a driving force for short-term macroeconomic growth. The multiplier effects of medical innovation on economic growth would therefore be negative or nil in the short term.

Using two waves of the Health and Professional Pathways (SIP) survey, this article studies workers' exposure to psychosocial risks (PSR) and its evolution between 2006 and 2010, in a context of economic crisis. We use Probit models to estimate the individual probability of exposure to the various PSRs conditional on the socioeconomic characteristics of individuals and the characteristics of their jobs. While we observe a general overexposure to PSRs among individuals aged 35 to 44, those with a bachelor's degree or those exposed to physical hardships, the exposure profiles appear to be clearly differentiated according to gender, occupational category and sector of activity. The identification of these overexposures and profiles should make it possible to better target prevention policies on these populations, which are not always those considered to be the most vulnerable on the labour market. A general increase in exposure to PSRs was observed over the period 2006-2010. The most striking increase concerns the lack of recognition. We analyze these changes according to the economic characteristics of the sectors of activity, the existence of a redundancy plan at company level and the professional mobility of individuals. There is no significant link between changes in exposure to PSR and sectoral differences in exposure to the crisis. On the other hand, we highlight a significant association between the existence of a redundancy plan at company level and the worsening of exposure to PSR. Finally, experiencing job mobility is associated with a significant reduction in exposure to PSRs. Because of the pro-cyclical nature of external job mobility, this link could constitute a transmission channel between economic crisis and exposure to PSRs.

This article studies the determinants of the decisions of members of a sibling group with two children to provide assistance to an elderly, lonely and dependent parent. The application of a semi-structural methodology, already used on European data (SHARE survey), makes it possible to distinguish between structural determinants (individual and family) and interactions (influence of the decision of one member of the sibling on the decision of the other). The results obtained from the 2008 French Handicap-Santé survey confirm the importance of sibling rank in understanding assistance behavior. Indeed, two distinct behavioural logics appear, both in the structural determinants and in the interactions. On the one hand, if children's help is influenced by the characteristics of the parent, whatever their rank, the elders seem to react mainly to the composition of the siblings, while the younger ones adapt their behaviour to their personal constraints. On the other hand, the involvement of the other sibling increases the usefulness of being a caregiver for the elders, while it decreases it for the younger siblings. The elders' help is therefore understood as the acceptance of a social assignment, whereas the younger siblings' help is based on a logic of arbitration, based on the comparison of the costs and benefits associated with help.

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Support for the presentation by N.Zerrar at the Modapa seminar on April 9, 2015. Summary of the article: In a context of aging population, different scenarios are considered to reform the organization and financing of the care of dependent elderly people. The role of individual insurance in the financing of dependency care is widely debated. At present, despite potentially substantial out-of-pocket expenses, few individuals have insurance coverage. This article aims to add to the existing literature by assessing the extent to which the preferences observed in the population limit this coverage. To do so, we mobilize the 2011 Pater survey (Patrimoine et préférences vis-à-vis du temps et du risque). At the request of the Fondation Médéric Alzheimer, the 2011 wave of the Pater survey included a complementary questionnaire on the perception of long-term care risk and insurance behavior (Pated). The Pater survey allows the construction of scores quantifying four dimensions of preferences likely to influence the perception of risk and the probability of purchasing insurance among individuals perceiving the risk: preference for the present, risk aversion, family altruism and presumed taste for informal help. The estimation results show a significant role for each of these dimensions in the demand for insurance. Nevertheless, even in a population with the most favorable preferences for insurance purchase, the simulations show that the rate of equipment would not exceed 20 percent. Increased recourse to individual provision through the generalization of private insurance coverage therefore seems difficult to envisage unless there is a strong evolution in the supply of insurance or public regulation encouraging or forcing the purchase of insurance.

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In the context of an aging population, various scenarios are being considered for reforming the organization and financing of care for dependent elderly people. The role of individual insurance in the financing of dependency is widely debated. At present, despite potentially substantial out-of-pocket expenses, few individuals have insurance coverage. This article aims to add to the existing literature by assessing the extent to which the preferences observed in the population limit this coverage. To do so, we mobilize the 2011 Pater survey (Patrimoine et préférences vis-à-vis du temps et du risque). At the request of the Fondation Médéric Alzheimer, the 2011 wave of the Pater survey included a complementary questionnaire on the perception of long-term care risk and insurance behavior (Pated). The Pater survey allows the construction of scores quantifying four dimensions of preferences likely to influence risk perception and the likelihood of purchasing insurance among individuals perceiving the risk: preference for the present, risk aversion, family altruism and the presumed taste for informal help. The estimation results show a significant role for each of these dimensions in the demand for insurance. Nevertheless, even in a population with the most favorable preferences for insurance purchase, the simulations show that the rate of equipment would not exceed 20%. Increased recourse to personal insurance through the generalization of private insurance coverage therefore seems difficult to envisage unless there is a strong evolution in the supply of insurance or public regulation encouraging or forcing the purchase of insurance. JEL codes: C25, D91, G22, I12, I18, J14. Keywords : dependence, loss of autonomy, dependence insurance, insurance demand, present preference, risk aversion.

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In a context where academic difficulties within the educational system are accumulating, followed by professional difficulties in an increasingly selective job market, the question of success often emerges in the interrogations of many researchers. It is the central theme of these XXIst days of the longitudinal.

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In the economic literature, many studies attempt to explain why individuals insure themselves so little against LTC. On the supply side, various possible obstacles to the development of the LTC insurance market have already been pointed out in the literature. Recent estimates show, however, that supply-side limitations are not sufficient to explain the slow development of the market: even if insurance were less expensive and the coverage offered more extensive, the majority of individuals would still not take out insurance. It is therefore necessary to look for explanations on the demand side of LTC insurance. This article aims to enrich the existing literature by empirically studying the role of risk perception in the decision to take out LTC insurance, based on direct observation of individual preferences (risk aversion, preference for the present) made possible by the 2012 wave of the "Preferences and Wealth in relation to Time and Risk" (PATER) survey. In addition to the effect of socio-demographic characteristics, the econometric estimates carried out highlight the role of individual preferences in LTC risk coverage behaviour. Preference for the present is thought to play an important role in the perception of LTC risk, while risk aversion explains the fact of insuring against this risk among those who envisage the possibility of one day being in a LTC situation.

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In the face of an aging population, the expected increase in the demand for long-term care raises the question of the role that our societies wish to entrust to families in the care of dependent elderly people. In this research, we conduct three micro-econometric analyses of individual and family caregiving behaviors. Three major results emerge. First, the evidence of an interdependence of caregiving behaviours within the family leads us to question the idea of a programmed decrease in informal care. Secondly, the reduction in the supply of work beyond a certain volume of assistance points to the limits of a public policy aimed at both increasing the activity of older people and keeping the oldest populations at home. Finally, the use of public assistance for caregiving has a relatively modest effect of crowding out family assistance.