title: The non-take up of long-term care benefit in France: A pecuniary motive?
abstract: With aging populations, European countries face difficult challenges. In 2002, France implemented a public allowance program (APA) offering financial support to the disabled elderly for their long-term care (LTC) needs. Although currently granted to 1.2 million people, it is suspected that some of those eligible do not claim it--presenting a non-take-up behavior. The granting of APA is a decentralized process, with 94 County Councils (CC) managing it, with wide room for local interpretation. This spatial heterogeneity in the implementation of the program creates the conditions for a "quasi-natural experiment", and provides the opportunity to study the demand for APA in relation to variations in CCs' "generosity" in terms of both eligibility and subsidy rate for LTC. We use a national health survey and administrative data in a multilevel model controlling for geographical, cultural and political differences between counties. The results show that claiming for APA is associated with the "generosity" of CCs: the population tends to apply less for the allowance if the subsidy rate is in average lower. This pecuniary trade-off, revealed by our study, can have strong implications for the well-being of the elderly and their relatives.
authors: Aix-Marseille Université (Aix-Marseille School of Economics, GREQAM EHESS), Vieille Charité, 2 rue de la Charité, 13002, Marseille, France; LIRAES (EA 4470)-Université Paris-Descartes, Sorbonne Paris Cité, 45 rue des Saints Pères, 75006, Paris, France. Electronic address: yves.arrighi@gmail.com.
authors: Yves
authors: Y
authors: Arrighi
authors: Aix Marseille Université, (Aix-Marseille School of Economics, SESSTIM UMR 912, Inserm IRD), 23 rue Stanislas Torrents, 13006, Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, 23 rue Stanislas Torrents, 13006, Marseille, France. Electronic address: berengere.davin@inserm.fr.
authors: Bérengère
authors: B
authors: Davin
authors: Aix-Marseille Université (Aix-Marseille School of Economics, GREQAM EHESS), Vieille Charité, 2 rue de la Charité, 13002, Marseille, France. Electronic address: alain.trannoy@univ-amu.fr.
authors: Alain
authors: A
authors: Trannoy
authors: Aix-Marseille Université (Aix-Marseille School of Economics, GREQAM EHESS), Vieille Charité, 2 rue de la Charité, 13002, Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, 23 rue Stanislas Torrents, 13006, Marseille, France. Electronic address: bruno.ventelou@inserm.fr.
authors: Bruno
authors: B
authors: Ventelou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities; D004608:Eligibility Determination; D005260:Female; D005602:France; D006306:Health Surveys; D006801:Humans; D008134:Long-Term Care / Q000191:economics* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D015999:Multivariate Analysis; D011057:Politics
keywords: Long-term care; Multilevel model; Non-take-up; Social benefit