France

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Health systems in transition
France
in designing health policy and in the management of health agencies and other
institutions. Overall, this reform, while addressing important issues in the
system, mostly draws upon previously proposed measures and mechanisms
with very little innovation.
Coping with the growing demand for long-term care for the elderly:
reform to prevent and provide for loss of autonomy
The first part of a two-step plan to address loss of autonomy (projet de loi
relatif à l’adaptation de la société au vieillissement) is expected to be enacted
by the end of 2015 and to be operational by mid-2016. The first step focuses
on measures designed to facilitate ageing in place, with the key measure
consisting of increased ceilings and reduced individual financial participation
under the APA (see section 3.6) to pay for assistance at home for an estimated
700 000 dependent frail elderly individuals. Other provisions of the proposed
law include financing of measures to prevent and delay the loss of autonomy;
adaptation of housing options, from new technologies for automation in
private homes to modernization of nonmedical collective housing facilities,
renamed autonomy residences (résidences autonomie; see section 5.8.1); and
respite assistance for caregivers. These measures will be financed by CASA
(enacted in 2013 as described above), which is estimated to raise €645 million
per year. However, most of the 2013 and 2014 revenues raised were not kept
for the reform but channelled to cover deficits in an unrelated social security
programme. Starting in 2015, the CASA revenues should be fully dedicated to
financing the autonomy reform.
The second step of the reform will focus on institutional care, in particular
reducing OOP payments for nursing home residents. Once more, the most
significant challenge will be finding the revenues to finance expanded public
coverage of institutional care. There is actually no political declaration on
suggested mechanisms and one can wonder if this will remain a “ghost reform”
after more than a decade of promised long-term care financing reforms that
were repeatedly delayed and ultimately not acted upon.