Long Term Care System: Is There Proximity between Supply and Demand in France?

Amélie Carrère, Université Paris Dauphine

Context: In France, during the 1960’s, people have moved from rural to urban areas leading to the development of urban centres that concentrate economic activity. Some people still live in areas faraway from these centres: 5% in 2010. In the same year, elderly people lived more in these isolated areas (8%). They therefore are at higher risks of living in cities providing little economic activity and probably few formal care or medical facilities useful to stay longer at home. Nevertheless, areas with higher prevalence of disability are also areas where the supply for long term care is higher. Is the supply for home care services related to the need of assistance and to the entrance in a specialized institution? If so, what are the reasons?

Method: I used CARE survey (n=15000 individuals aged 60 and over living either in the community or in specialised institution). I classified the supply into ten categories: home care services, nursing-homes, “residences-autonomies” (dwellings for old people close to nursing-home but providing no medical assistance), temporary dwellings, general practitioners, nurses, dentists, physiotherapists, ophthalmologists and pharmacists. For the first four categories, I calculated distances between the person’s place of residence (or previous place of residence if living in nursing home) and the closest facility. For the other facilities, I used the Local Potential Accessibility (LPA) which is a local indicator of accessibility to health care at a city level. I conducted multi-level logistic regressions to identify the role of healthcare provision on the risk of having disability and of living in a specialised institution.

First results: Some counties have specialised their supply in nurses and their risk of disability is larger, in the community population. Others have specialised their supply in nursing-home and their risk of disability is lower in the community population.

Presented in Poster Session 2