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Décisions de recours au système de soins dans la prise en charge des personnes âgées dépen­ dantes : un modèle de choix discret dynamique

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  • Agnès Gramain
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    Abstract

    [eng] Long-Term Care Choices of Disabled Elderly and their Family Caregivers : a Dynamic Discrete Choice Model . by Agnès Gramain . This article presents an application of a dynamic discrete choice model to the analysis of care arrangement of disabled elderly. This method allows us to examine the main determinants of the demand for in-home services and nursing-home admission. Data were collected in 1993 and 1996 in southern France, and describe the evolution of care arangement for 155 elderly and their main caregivers. Our results show that the call for professionnal help is obviously a response to time and budget arbitrage. They also indicate that ageing and disability increasing do not systematically induce a higher probability of formal help use. The care arrangements of disabled elderly seem to be very stable whatever the type of formal services and the level of incapacities. Our estimations give some elements for the evaluation of the in-home services' efficiency in terms of reduced probability of nursing-home admission. It suggests that the nursing-home admission probability depends of a rather complex profile of characteristics including the type of disability the elderly persons suffer from, their socio-economic status and the formal and informal caregivers that help them. [fre] Décisions de recours au système de soins dans la prise en charge des personnes âgées dépendantes : . un modèle de choix discret dynamique par Agnès Gramain . Cet article présente un modèle de choix discret formalisant les recours aux services d' aide professionnels (aides à domicile et établissements d'hébergement pour personnes âgées) dans la prise en charge des personnes âgées dépendantes. Les données utilisées proviennent d'une enquête réalisée en 1993 et 1996 dans le sud de la France auprès de 155 aidants de personnes âgées dépendantes. Les résultats indiquent que les choix de prise en charge sont bien guidés par des arbitrages temporels et budgétaires. Ils montrent aussi que le vieillissement des individus et l'accroissement de leur dépendance ne s'accompagne pas systématiquement d'une augmentation des recours aux services professionnels. L'analyse des trajectoires de prise en charge souligne la forte inertie des recours, et suggère que la stabilité des prises en charge à domicile ne dépend pas seulement du type de professionnels impliqués ou des caractéristiques médicales de la personne aidée mais plutôt de profils de caractéristiques incluant aussi bien l'état de santé de la personne aidée que la configuration d'aide profane et professionnelle et la situation socio-économique de la personne aidée et de son aidant.

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    Bibliographic Info

    Article provided by Programme National Persée in its journal Économie & prévision.

    Volume (Year): 129 (1997)
    Issue (Month): 3 ()
    Pages: 239-254

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    Handle: RePEc:prs:ecoprv:ecop_0249-4744_1997_num_129_3_5876

    Note: DOI:10.3406/ecop.1997.5876
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    Web page: http://www.persee.fr/web/revues/home/prescript/revue/ecop

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    1. David M. Cutler & Louise Sheiner, 1994. "Policy Options for Long-Term Care," NBER Chapters, in: Studies in the Economics of Aging, pages 395-442 National Bureau of Economic Research, Inc.
    2. Ettner, Susan L, 1994. "The Effect of the Medicaid Home Care Benefit on Long-Term Care Choices of the Elderly," Economic Inquiry, Western Economic Association International, vol. 32(1), pages 103-27, January.
    3. Rust, John, 1988. "Statistical models of discrete choice processes," Transportation Research Part B: Methodological, Elsevier, vol. 22(2), pages 125-158, April.
    4. Sloan, Frank A. & Thomas J. Hoerger & Gabriel Picone, 1996. "Effects of Strategic Behavior and Public Subsidies on Families' Savings and Long-Term Care Decisions," Working Papers 96-01, Duke University, Department of Economics.
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