The 2nd HPD report - Health Policy Monitor

2003: Reform
proposal grants
rights for those
needing care
Easier
admission and
administration
Controversy about
proposed new social
security pillar
Pooled
fund for
dependency
risks
Idea
Pilot
Policy Paper
Legislation
Adoption
Evaluation
Change
In November 2003, the Prime Minister presented the main lines
of the future reform, labeled “solidarity reform for the dependent,”
grouped under three headings:
– Acknowledgment of new rights. These rights are not as clearly
defined for the elderly which should benefit from “better living
conditions” as they are for the handicapped: the agenda clearly
states that they will be compensated for the additional expenses
caused by the handicap, which is new in France;
– Improved access to these rights. For the elderly, a series of
measures will aim at helping them to live longer at home (tax
rebates for equipment of the house, better remuneration of
nursing care) and at increasing medical assistance in retirement
and nursing homes (more staff, an air-conditioned room
in each facility). For the handicapped, the compensation mentioned
above is included in a wider reform, presented to the
press by deputy minister Marie-Thérèse Boisseau at the end of
January 2004, whose purpose is to update a 1975 law and to
improve the integration of the handicapped in society.
The plan foresees the creation of one-stop centers to improve
access to services, decentralization of the administration of
some services, simplification of the pricing of services in nursing
homes at the department level.
– Reshaping and consolidation of funding. The government has
set to create a fifth branch of social security (in addition to
health insurance, family benefits, pensions and a fourth branch
which collects contributions). This aspect of the reform has so
far been the only one to raise a public debate.
This new Caisse Nationale de Solidarité pour l’Autonomie
(solidarity fund for autonomy), would focus on a specific risk,
dependency, and consequently would cover both the handicapped
and the elderly. It would pool existing resources including the
APA (Allocation Personnalisée d’Autonomie or Benefit for an
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