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Decentralized policies and formal care use by the disabled elderly


  • Quitterie Roquebert

    () (PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Panthéon-Sorbonne - ENS Paris - École normale supérieure - Paris - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique, PSE - Paris School of Economics)

  • Remi Kabore

    (ISPED - Institut de Santé Publique, d'Epidémiologie et de Développement - Université Bordeaux Segalen - Bordeaux 2)

  • Jerome Wittwer

    (ISPED - Institut de Santé Publique, d'Epidémiologie et de Développement - Université Bordeaux Segalen - Bordeaux 2)


In a context of population ageing, public policies encourage the utilization of pro- fessional home care for the elderly living in the community. This chapter studies the determinants of professional home care use by the disabled elderly in the French con- text. It focuses on the e_ects of the regulation of the supply and the generosity of public _nancing. We use departmental variations in both the regulation of providers and the implementation of the main program devoted to the disabled elderly, the APA policy. We exploit an original survey on departmental practices matched with the HSM survey to estimate the determinants of formal care use, at the extensive margin. We _nd no e_ect of the departmental generosity while, on the supply side, when non-regulated providers | whose quality is uncertain and price is lightly regulated | dominate the market, the disabled elderly have a lower probability to use formal home care. Our results contribute to discuss both the questions raised by the decentralization of a national policy and the recent reform of the home care sector requiring all home care structures to be regulated.

Suggested Citation

  • Quitterie Roquebert & Remi Kabore & Jerome Wittwer, 2018. "Decentralized policies and formal care use by the disabled elderly," PSE Working Papers halshs-01877829, HAL.
  • Handle: RePEc:hal:psewpa:halshs-01877829
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    1. repec:wly:hlthec:v:26:y:2017:i:9:p:1162-1174 is not listed on IDEAS
    2. Cécile Bourreau-Dubois & Quitterie Roquebert & Agnès Gramain, 2015. "Les disparités départementales dans la mise en oeuvre de l’APA à domicile, reflets des choix de politiques locales ?," Université Paris1 Panthéon-Sorbonne (Post-Print and Working Papers) hal-01158419, HAL.
    3. James Gaughan & Hugh Gravelle & Rita Santos & Luigi Siciliani, 2013. "Long term care provision, hospital length of stay and discharge destination for hip fracture and stroke patients," Working Papers 086cherp, Centre for Health Economics, University of York.
    4. Cécile Bourreau-Dubois & Agnès Gramain & Helen Lim & Jingyue Xing, 2014. "Impact du reste à charge sur le volume d'heures d'aide à domicile utilisé par les bénéficiaires de l'APA," Université Paris1 Panthéon-Sorbonne (Post-Print and Working Papers) halshs-00973938, HAL.
    5. Roméo Fontaine, 2012. "The Effect of Public Subsidies for Formal Care on the Care Provision for Disabled Elderly People in France," Post-Print halshs-01227866, HAL.
    6. Stabile, Mark & Laporte, Audrey & Coyte, Peter C., 2006. "Household responses to public home care programs," Journal of Health Economics, Elsevier, vol. 25(4), pages 674-701, July.
    7. Van Houtven, Courtney Harold & Norton, Edward C., 2004. "Informal care and health care use of older adults," Journal of Health Economics, Elsevier, vol. 23(6), pages 1159-1180, November.
    8. Arrighi, Yves & Davin, Bérengère & Trannoy, Alain & Ventelou, Bruno, 2015. "The non-take up of long-term care benefit in France: A pecuniary motive?," Health Policy, Elsevier, vol. 119(10), pages 1338-1348.
    9. Robin Hege & Quitterie Roquebert & Marianne Tenand & Agnès Gramain, 2014. "La tarification des services d'aide à domicile : un outil au service des politiques départementales ?," Université Paris1 Panthéon-Sorbonne (Post-Print and Working Papers) hal-01092496, HAL.
    10. Gansel, Yannis & Danet, François & Rauscher, Catherine, 2010. "Long-stay inpatients in short-term emergency units in France: A case study," Social Science & Medicine, Elsevier, vol. 70(4), pages 501-508, February.
    11. Barnay, Thomas & Juin, Sandrine, 2016. "Does home care for dependent elderly people improve their mental health?," Journal of Health Economics, Elsevier, vol. 45(C), pages 149-160.
    12. repec:kap:ijhcfe:v:17:y:2017:i:3:d:10.1007_s10754-017-9214-z is not listed on IDEAS
    13. Agnès Gramain & Solène Billaud & Cécile Bourreau-Dubois & Helen Lim & Florence Weber & Jingyue Xing, 2012. "La prise en charge de la dépendance des personnes âgées: les dimensions territoriales de l'action publique," Université Paris1 Panthéon-Sorbonne (Post-Print and Working Papers) halshs-00705569, HAL.
    14. Moulton, Brent R, 1990. "An Illustration of a Pitfall in Estimating the Effects of Aggregate Variables on Micro Unit," The Review of Economics and Statistics, MIT Press, vol. 72(2), pages 334-338, May.
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    home care; supply regulation; decentralization; long-term care;

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