Aimée Kingsada, Thomas Blavet et Anais Cheneau membres de l’équipe de la Chaire exposeront leurs travaux lors de la conférence internationale de la European Health Economics Association qui se tiendra à Vienne (Autriche) du 30/06 au 03/07/2024.
La présentation d’Aimée Kingsada portera sur : “Impact of unmet needs on the risk of falls among frail older adults in Europe”.
Written with John McHugh (Columbia University) Associated Researcher at Aging UP! Chair, Jonathan Sicsic (Université Paris Cité) Scientific Director of Aging UP! Chair et Thomas Rapp (Université Paris Cité) Director of Aging UP! Chair.
Frail older individuals are more susceptible to falls and might require formal, long-term care. Despite this, they may not qualify for public financial assistance since eligibility criteria for aid are often based on disability criteria such as physical limitations. In this study, we investigate how unmet formal care needs affect the risk of falls in frail older adults. We utilized longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE) and employed Two-Way Fixed Effects models. Our findings demonstrate that for a given frail individual, having unmet formal care needs for Activities of Daily Living (ADL) leads to a 20-percentage point (pp.) increase in the risk of falls, and having unmet formal care needs for Instrumental Activities of Daily Living (IADL) leads to a 10 pp. increase in fall risk. Our results are robust to selection bias, and consistent across all sensitivity and heterogeneous analyses.
La présentation d’Anais Cheneau portera sur :
“New estimate of the value of informal care in France based on the care Utility fonction”.
Objectives: In Alzheimer’s disease (AD), informal care represents more than 80% of total care used when patients are living in the community (Paraponaris and Davin, 2015; Rapp et al., 2011). Therefore, an accurate valuation of informal caregiving is needed to obtain the true cost of AD (Jonsson and Wimo, 2009). Most articles that tried to estimate the cost of AD rely on the so-called ‘replacement’ methodology to value informal caregiving (Costa et al., 2012). As most informal caregivers in AD are retired spouses or unemployed people, there is no market value for their time. The replacement methodology consists in replacing the cost of informal caregiving by the cost of an activity that has been valued by a labor market, usually maid (unskilled) services. It is widely used because of its simplicity but relies on the strong (and potentially flawed) assumption that an hour of informal care has the same value as an hour of maid services. Little attention has been dedicated to explore the validity of the ‘replacement assumption’. Consequently, there is need to further examine the relevancy of the assumption that one hour of maid services is a valid proxy hour of informal care. In this paper, we explore the validity of the replacement assumption using an original methodology.
Methods: In this paper, we determine the relationship between the price of informal caregiving and the price of professional care from the first-order condition of a theoretical model that maximizes informal caregivers’ satisfaction with providing informal care. We then estimate this price using quality of life and well-being data. Our sample consisted of 1131 patients diagnosed with mild to moderate AD. Patients were recruited between June 2003 and July 2005 from 50 French memory clinics.
Results: We find that the value of informal care is 18% higher than the value of formal care. According to that result, the total cost for informal care of AD patients in France is estimated to be €4.2 billion per year.
Discussion : Our result shows that the replacement methodology leads to underestimate the price of informal caregiving, mainly because it does not control for the burden of care associated with informal caregiving provision. In France, this means that one hour of informal caregiving should be valued around €14, not €12 as found in previous research (Paraponaris and Davin, 2015 ; Gerves-Pinquie et al., 2014). Our results support the idea of considering informal caregivers’ preferences in the informal care valuation process.
Thomas Blavet présentera :
“Adverse Selection, Self-reported Probabilities and Long-term Care Insurance Take-up in the United States”.
A large share of the United States population needs to purchase long-term care insurance (LTC insurance) to finance formal care expenditures. However, the take-up of LTC insurance is currently very limited, suggesting that some people tend to underestimate their future needs for long-term care (LTC) services. This paper explores the correlation between ex-ante private information of individuals and LTC insurance take-up.
We use the last 12 waves of the Health and Retirement Study, covering the period 1996-2018, and restrict our panel to individuals aged between 65 and 75. We analyze the presence of adverse selection in the LTC insurance market using the self-reported probabilities of survival and moving to a nursing home. For three groups of life expectancy miscalibration (consistent, negative, and positive deviations), we estimate the correlation between self-reported probabilities and the LTC insurance take-up using random effects linear probability models. We find that individuals who report a probability of being alive close enough to the objective probabilities are more likely to purchase LTC insurance when their two self-reported probabilities increase.
Our results highlight adverse selection in the LTC insurance market and potentially the need to modify contracts to increase population coverage.