ANR

The research project

How does the hourly cost of professional home care influence dependent elderly persons' demand for such services? This is the main question that brings together a dozen researchers in economics in the MODAPA project.
Professional home care services for dependent elderly persons is partially subsidised by a public aid programme, the Personalised Autonomy Allocation (French APA–Allocation Personalisée d'Autonomie), which is formulated at the national level and implemented by the departmental councils. The beneficiaries of this public aid pay only a part of the price of each hour of service, the “copayment amount”, and this out-of-pocket amount is likely to influence their consumption of professional care services. The objective of the MODAPA project is to quantify the demand sensitivity with respect to out-of-pocket payments amongst dependent elderly persons living at home, and to explore the implications for the modalities of this public aid for this vulnerable segment of the population.

IRESP
CNSA
CNRS

Partners

This project has received financial support from the French Public Health Research Institute (IRESP) and the National Research Agency (ANR) for three years beginning September 2014. The MODAPA team cooperates with several departmental councils in metropolitan France, as well as with the French Directorate of Research, Studies, Evaluation and Statistics (DREES; under the Ministry of Social Affairs and Health) and the Research Mission (MIRE) of the same Ministry.
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Centre d'économie de la Sorbonne
Université de Lorraine
Université Paris 1

This site is intended for people involved in or otherwise concerned by the long-term care of functionally dependent elderly persons — as the care-receiver or the caregiver, as a professional in the home care service sector, as a state or non-state actor in the social policy process, or simply as a citizen.


Contents:

Public support for dependent elderly people raises critical questions for public policy. In particular, the amount of out-of-pocket payments which remain the responsibility of the beneficiaries when they use professional home care services may have an effect on their consumption of public aid. An analysis of the effect of out-of-pocket payments on the consumption of professional care services is interesting from the point of view of support for public action directed towards dependent elderly people, as well as the progress of scientific knowledge. To understand these issues, it is helpful to be clear on the definition of some important terms.
<< Scientific challenges Some definitions Back to Issues >>

Regarding home care services

Formal care, informal care Formal care is paid professional care supplied to a dependent person either by a home care and assistance service provider (French SAAD) or by a person that the dependent individual hires as an employee. Informal care is the help provided by the entourage of the dependent person (usually, family members).

Elasticity of demand for professional care
with respect to out-of-pocket cost
This is the responsiveness of the volume of professional care consumed to a change in the out-of-pocket cost to the individual (i.e. the change in the volume of care demanded resulting from a change in the out-of-pocket cost).
If demand is “elastic”, a change in the out-of-pocket cost results in a change in the volume of care consumed. For instance, an increase in the out-of-pocket cost decreases the number of hours of professional home care service demanded/consumed.
If demand is “inelastic”, a change in the out-of-pocket cost does not change the volume of care demanded/consumed. (NB: this last definition corresponds to “perfectly inelastic demand” in economics textbooks.)

Regarding the Personalised Autonomy Allocation (French APA)
The APA programme Created in 2001 (Act No. 2001-647 dated 20 July 2001) and implemented in 2002, the Personalised Autonomy Allocation (APA) is the main public aid programme for the dependent elderly in France. This allowance, co-financed by the French National Fund for Solidarity and Autonomy (CNSA) and the Departmental Councils, subsidises a portion of the cost of care required by elderly persons who are dependent to some extent. Beneficiaries must be at least 60 years old and living at home or in an institution. For those at home, the APA can be used to help finance the cost of professional services for cleaning, grocery shopping and meal preparation, in addition to the activities of daily living such as personal hygiene and grooming.
GIR and AGGIR The GIR (Iso-Resource Group) is the assessed level of dependency of the elderly person, measured using a national evaluation tool called the AGGIR (Autonomy Gerontology Groups Iso-Resources) at the stage where an individual files an application for APA benefits. Based on an individualised assessment by the medical-social worker personnel of the Departmental Council, each APA applicant is placed in one of six categories, from GIR 6 (least dependent) to GIR 1 (most dependent). Only people in GIR 1 to 4 are eligible for the APA allowance.
Individualised care plan
(plan d'aide)
Once an applicant for APA is regarded as eligible (age and residency criteria, and between GIR 1 and 4), the medico-social team of the Departmental Council draws up a personalised care plan. It lists the activities for which the individual requires professional help and the number of hours required for the performance of these activities. This volume of hours of assistance is then converted into euros using a specific tariff (see definition, infra) adopted by the Departmental Council. The total cost of the individualised care plan thus calculated is subject to the legal limit set by the law governing the APA programme (i.e. the care plan cost is reduced to the legal limit if the calculated cost exceeds the legal limit).
Legal ceiling
applicable to eligible expenses (plafond légal)
The total cost of care services eligible for APA subsidy varies from one individual to another, depending on each individual's needs as outlined in their personalised care plans. The total cost however must remain within the limits of a ceiling set by law, with a different ceiling amount for each assessed degree of dependency. Since 1 March 2016, the maximum allowable expenditure for a person classified GIR 1 is 1,713.08 euros per month. The other ceilings, for GIR 2, 3 and 4 respectively, are €1,375.54, €993.88, and €662.95.
Out-of-pocket payment
(reste-à-charge)
The difference between an individual's total expenditure on professional care services and the subsidy provided under the APA programme. The hourly out-of-pocket payment corresponds to the proportion of the hourly price of professional care services consumed that is borne by the APA beneficiary.
Subsidisation of the care plan Once the APA applicant is considered as eligible, and the medico-socialwork team of the Departmental Council has drawn up the individual's personalised care plan as well as ensured that the total cost of the care plan does not exceed the legal maximum applicable for the assessed degree of dependence (see “Valuation of the care plan”), the team will proceed to calculate the APA allowance. This process, called “subsidisation of the care plan” involves calculating the beneficiary's financial contribution towards the total cost of his care plan. To evaluate the total cost, the Departmental Council's team uses either a reference rate fixed by the Departmental Council itself or the per hour fee charged to the APA beneficiary by the chosen service provider. In the case of a reference rate, the difference between the price charged by the service provider and the reference rate is called a “dépassement” (excess fee). Some Departmental Councils provide an additional subsidy to pay for this excess fee, while others leave it to the APA beneficiary to bear the difference.
NB: In the vast majority of departments, the rate used to calculate the subsidisation of the care plan is the same as that used in the valuation of the care plan.
Copayment rate
(taux de participation)
The law fixes the proportion of the cost of the individualised care plan which remains the responsibility of the APA beneficiary. This copayment rate is a function of the individual's income (couple's income divided by 1.7, for those living with a spouse). The copayment rate increases linearly from 0% for people with income not exceeding € 799.73 per month, to 90% for people whose income exceeds € 2,945.22 per month (as at 1 March 2016).
Reference rate To calculate the total cost of the care plan (see “Valuation of the care plan”) so as to compare it to the legal ceilings, or to calculate the amount of the APA allowance (see “Subsidisation of the care plan”), the Departmental Council may use a reference rate that is independent of the fee that the beneficiary will in fact be charged by his service provider for each hour of service rendered.
Valuation of the care plan During its visit to the home of an APA applicant, the medico-socialwork team of the Departmental Council lists the activities for which the elderly person needs assistance, and the respective number of hours of service required, so as to draw up the individual's personalised care plan. To compare the total cost of the individual's care plan to the legal ceiling amounts set for APA beneficiaries, the team needs to convert the number of hours into an amount in euros. To carry out this valuation of the care plan, the team uses either a reference rate established by the Departmental Council or the per hour fee charged by the individual's chosen service provider.
NB:
(1) The personalised care plan however is always stated in terms of the number of hours of care approved and not an amount in euros.
(2) In the vast majority of departments, the rate used in the valuation of the care plan is the same as that used to calculate the subsidisation of the care plan.
Regarding the professional home care service providers
Services d'Aide et d'Accompagnement à Domicile (SAAD) The SAAD are the organisations (whether associations, private companies or private organisations) that provide home care and support services, which includes help in the activities of daily living such as personal hygiene and grooming, as well as housekeeping. Medical/skilled care services are excluded, as these are provided by licensed home nursing service providers based on medical prescription.
Service provider (prestataire)
Agent (mandataire)
Direct hire (gré-à-gré)
Individuals obtain professional home care services via one of three modes of contractual service:
- Service provider: the individual buys the services offered by the service provider; the caregivers that perform the services in the home of the client are employees of the service providers (i.e. the service provider is responsible for the legal obligations as employer);
- Agent: the individual is legally the employer of the person that performs the home care service, but mandates an organisation to handle the administrative formalities such as recruitment and legal obligations;
- Direct hire: the individual himself hires a person to perform the home care services for him, and there is a direct employer-employee relationship in the eyes of the labour law.
Authorized service providers (services autorisés)
Accredited service providers (services agréés)
There are two types of professional home care service providers:
- Regulated service providers: regulated by the Departmental Council, and in general, obliged to charge their clients the hourly service fees as fixed by the Departmental Council. Regulated providers come under the ambit of the French Code de l’action sociale (régime de l’autorisation, loi du 2 janvier 2002).
- Accredited service providers: accredited by the national government, and subject to the French Labour code. Accredited providers are free to set their prices, on condition that they respect a maximum annual rate of change set by the Prefect (régime de l’agrément, loi du 26 juillet 2005).
Regarding the French territorial administration
Department
Departmental Council
The 13 administrative regions in metropolitan France are subdivided into 96 departments. Each department is governed by a Departmental Council, which is responsible for various policy areas such as education and culture and in particular, social policies targetting vulnerable segments of the population (young children, people living with a handicap, the elderly).
Prefect A Prefect in France is a civil servant who is the national government's representative at the departmental and the regional levels (departmental prefect, regional prefect). The Prefect of the department that is the capital of a region is concurrently the Prefect of that region.
<< Back to Issues Support for public policy Scientific challenges >>

Towards a reform of the long term care of the elderly Dependence and financing of its management affect a large part of the population, both directly (the dependent elderly, whose share in the population is increasing) and indirectly (the dependent persons' entourage, employees in the service sector assisting the dependent elderly, etc.). In addition, from 2025 onwards, if public policy remains as it is today, demographic changes are expected to lead to a significant increase in the proportion of public spending that goes towards the dependent elderly (approximately 0.30 percentage points of GDP in 15 years). The reform of public policies for the long term care of the elderly is thus a major concern in contemporary social policy circles.

Determining the sensitivity of demand to out-of-pocket payments in order to anticipate the impact of public policies The recently introduced reform of public policies for the management of old-age dependence focuses on a change in the parameters of the APA program, since the APA is the main public aid scheme for dependent elderly persons in France. Details of the reform announced thus far include changes to the schedule of co-payment rates and to the legal ceiling amounts available under APA. The result of these changes is a reduction in the total out-of-pocket payments that APA beneficiaries will be responsible for, and this is expected to have non-negligible consequences on the consumption of home care services for dependent elderly people.
An analysis of the elasticity of demand for professional home care services involves several questions:
  • If demand is elastic, how do changes in the cost of professional home care services, and hence the demand for such services, impact informal care provided by family members? Under what conditions can we expect substitution between professional and informal care, and to what extent are they substitutes?
    In addition, if the out-of-pocket payment decreases (as is the theoretical outcome of the current reform), to what extent can professional home care service providers meet the increased demand for formal care?
  • If demand is inelastic (the demand for professional care services does not change much, if at all, despite a change in the out-of-pocket cost to individuals), it is necessary to understand the overall impact on the dependent elderly persons affected. If the out-of-pocket cost increases, for example, does the dependent elderly person decrease his or her consumption of other goods or services? If so, what are the consequences for their well-being? If the out-of-pocket cost decreases, on the other hand, and demand is inelastic, what are the consequences in this case?
  • Analyses of the elasticity of demand for formal home care services with respect to out-of-pocket costs would thus contribute towards improving recommendations for public policy action, both in terms of economic efficiency and optimal distribution of social solidarity.
<< Support for public policy Scientific challenges Definitions >>

Understand the implementation of a partly decentralised social policy Considered as the “leaders” of public social action since 2004 (resulting from the “decentralisation law” enacted that year), the French departments are in large part responsible for the implementation of public policies towards the dependent elderly. The governing councils of the departments are responsible for the allocation and management of the APA aid scheme within their respective departments. It is they in particular who decide on certain programme parameters which determine the out-of-pocket cost to APA beneficiaries (see 'Calculating the out-of-pocket payment'). A study of the modes of organisation and the room for manoeuvre in policy parameters under the control of the departmental councils therefore improves our understanding of the implementation of social policies by the departments in the context of the different levels of social policy actions in France (national, regional and departmental).

Improve the availability of data and test new methods for econometric identification There are very few studies to date on the demand for professional home care services amongst elderly dependent persons in France. The main explanation for this lies in the difficulties involved in collecting the necessary data for such analyses. To remedy these shortcomings, the MODAPA team uses several types of statistical data and qualitative analyses (see 'Data used'). In addition, the specificity of the context and the data we have managed to obtain open up the possibility of testing the benefits of using partial identification methods recently developed and as yet not widely implemented in the field of applied economics (see 'Econometric Strategies').
Studying the sensitivity of the demand for professional home care services to out-of-pocket payments involves several questions:
- how do we calculate the out-of-pocket (OOP) payments borne by APA beneficiaries within the framework of a partly decentralised public policy?
- what are the appropriate data needed to reconstruct the out-of-pocket payments?
- what econometric strategies permit an estimation of the effect of out-of-pocket payments on the demand for professional home care services amongst the dependent elderly?
<< Back to Approach Calculating the out-of-pocket payment Data used >>
How do we calculate the out-of-pocket payments borne by APA beneficiaries within the framework of a partly decentralised public policy?

The out-of-pocket payment depends on the price charged for an hour of service and on the APA amount granted The APA is a partial aid; it covers only part of the total expenditure on professional home care services. For each hour of home care service consumed, the APA beneficiary pays an hourly out-of-pocket payment. This out-of-pocket payment depends on the price charged by the service provider, and the allowance that the APA beneficiary receives to cover part of the hourly cost of the service. These two elements are themselves functions of several parameters.

What determines the price charged for one hour of home care? The price charged for an hour of home care service depends on:
  • the contractual relationship by which the service is offered (service provider, agent, or direct hire);
  • the service regime (Authorisation or Accreditation), in the case of a service provider;
  • the tariff fixed by the Departmental Council for the service provider, in the case of an Authorised provider subject to pricing by the Departmental Council;
  • the market environment and competitive pressures, which influence market prices.

What determines the APA allowance amount?
The parameters defined by law
The allowance received by an APA beneficiary depends on both parameters fixed at the national level (by law) and parameters established by the Departmental Council governing the beneficiary's department of residence.
At the national level, the law determines:
  • the eligibility requirements for applicants – at least 60 years old, regular resident in France for at least 3 months, assessed degree of dependency between GIR 1 and GIR 4;
  • the ceiling for eligible expenditures as prescribed in the individualised home care plan, which varies with the individual's assessed degree of dependency;
  • the co-payment rate of the beneficiary, which depends on his income.

What determines the APA allowance amount?
The parameters set by the Departmental Council
The governing Council of each Department is responsible for the implementation of APA procedures within the department and the definition of a number of essential parameters:
  • the assessment of individuals' needs (determination of the degree of dependence –the GIR– and definition of the individualised care plan) is performed by a medico-social worker team from the Departmental Council;
  • the valorisation rate (used to convert the number of hours in each individual's care plan into the cost in terms of euros) is determined by the Departmental Council.

The Departmental Council is also the regulatory authority for the professional home care services sector within the department, granting the status of “Authorised” to certain service providers and, for the majority of Councils, fixing the tariffs to be charged by these Authorised providers.
<< Calculating the out-of-pocket payment Data used Econometric strategies >>
What are the appropriate data needed to reconstruct the out-of-pocket payments?

Quantitative data from various sources The variety of the data used is one of the strengths of the MODAPA project. Indeed, our work is based on econometric analyses of several types of data (the majority of which is confidential and made exclusively available for research within the project):
  • anonymised administrative files of APA beneficiaries, collected by Modapa researchers at the level of the department through specific collaboration agreements with a number of Departmental Councils;
  • samples of the administrative files on APA beneficiaries submitted by the Departmental Councils to the central government;
  • anonymised administrative files from a number of professional home care service providers;
  • survey data on departmental practices relating to the APA aid programme;
  • representative survey data of the elderly and disabled population in France, such as the 'Enquête Handicap Santé Ménages', 2008 (DREES/Insee)

Participation in the development and monitoring of a national survey The MODAPA research team also participates in the development, monitoring and exploitation of data from the ad hoc survey Capacité, Aides et Ressources des Seniors (CARE; “Capacity, Aid and Resources for Seniors”), conducted by the DREES. This survey will provide data, from the year 2015, on the volume of care and out-of-pocket payments for a sample of 15 000 persons in metropolitan France.

Qualitative data from surveys Beyond the above standardised data, research within the MODAPA project also benefits from field studies previously conducted within the framework of a research project on the management of dependence due to handicap or old age. The MODAPA project relies in particular on eight monographs on departmental practices, elaborated on in partnership with sociologists since 2010 (Enquête Territoire–Territoire Survey).
<< Data used Econometric strategies Back to Approach >>
What econometric strategies permit an estimation of the effect of out-of-pocket payments on the demand for professional home care services amongst the dependent elderly?

Three alternative strategies for estimation Using the data described above, three strategies are being implemented:
  1. Estimation of the effect of out-of-pocket payment on the volume of professional care services consumed, with exact information on the hourly out-of-pocket payment: we use the administrative files of a Departmental Council on APA beneficiaries who are clients of an “Authorised” service provider and for whom the Departmental Council uses a “Solvency rate” equal to the price charged by the service provider. This strategy has already been implemented on data from a French department (see Bourreau-Dubois et al, 2014, in Publications). It will be reproduced using data from other departments so as to test the robustness of the results. (see Roquebert, Tenand, 2016 in Publications).
  2. Estimation of the effect of out-of-pocket payment on the volume of professional care services consumed, using interval estimates of out-of-pocket payment: we will use data on the volume of professional care services consumed by APA beneficiaries available in the routine submissions that Departmental Councils regularly send to the DREES, coupled with information on out-of-pocket payment intervals estimated by the Territoires Survey.
  3. Estimation of the effect of the volume of professional care services on the volume of informal care: we will use data from the Handicap-Health 2008 Survey (Enquête Handicap-Santé; in the sections on “Households” and “Caregivers”).

Towards simulations of the effects of various changes in public policy These estimation strategies will allow us to simulate the impact of changes in the modalities of calculating the out-of-pocket payment (e.g. modification of the schedule of co-payment rates, changes in the legal ceiling amounts, adjustment of the prices set for Authorised services, evolution of market prices for home care services) on public funding of aid towards dependent elderly persons in France.
Results from the project are presented in various formats:
- MODAPA Notes, which offer 4-page syntheses of studies carried out within the framework of the project (in French) ;
- Articles published in scientific journals;
- Working Papers, which present pre-publication results;
- Reports, which present results from specific studies for specific partner organisations.
You can also find here other resources produced by the MODAPA project:
- the Territoire Survey devoted to French Departmental policies for the management of dependent elderly persons living at home (in French).
- the statistics relating to the results from the Territoire Survey (forthcoming).
<< Retour à la page Publications Notes Modapa Les articles >>
Les déterminants du volume d'aide professionnelle pour les bénéficiaires de l'APA à domicile : le rôle du reste-à-charge
Note MODAPA n°1
Octobre 2014
La tarification des services d'aide à domicile : un outil au service des politiques départementales ?
Note MODAPA n°2
Décembre 2014
Les disparités départementales dans la mise en oeuvre de l’APA à domicile, reflets des choix de politiques locales ?
Note MODAPA n°3
Juin 2015
La visite à domicile dans le cadre de l'APA : quel effet de la formation initiale des personnels sur leurs pratiques ?
Note MODAPA n°4
Décembre 2015
<< Notes Modapa Les articles Les documents de travail >>
Tarification publique et normalisation des processus de production dans le secteur de l'aide à domicile pour les personnes âgées
Agnès Gramain et Jingyue Xing
Revue française des affaires sociales, 2012/2 - n° 2-3, p.218-243
Écarts de mise en oeuvre ou politiques publiques locales : l’exemple de l’aide aux personnes âgées dépendantes à domicile
Agnès Gramain, Robin Hege et Quitterie Roquebert
Pouvoirs locaux / Les cahiers de la décentralisation, n°105 - 2015/II, p.76-80
<< Les articles Les documents de travail Les rapports >>
Impact du-reste-à-charge sur le volume d'aide à domicile utilisé par les bénéficiaires de l'APA
Cécile Bourreau-Dubois, Agnès Gramain, Helen Lim, Jingyue Xing
Document de Travail du Centre d'Economie de la Sorbonne, n°2014-24
La solvabilisation des plans d'aide APA comme outil décentralisé d'assurance et de redistribution
Cécile Bourreau-Dubois et Agnès Gramain
Document de Travail du Beta, n° 2014-8
Can formal home care reduce the burden of informal care for elderly dependents? Evidence from France.
Louis Arnault et Andreas Goltz
Université de Dauphine, WP n°3/2014
La demande d'aide à domicile est-elle sensible au reste-à-charge : une analyse multi-niveaux sur données françaises.
Robin Hege
Document de Travail du Centre d'Economie de la Sorbonne, n°2016.22
Pay less, consume more? Estimating the price elasticity of demand for home care services of the disabled elderly
Quitterie Roquebert, Marianne Tenand
HEDG working paper, WP 16/16
<< Les documents de travail Les rapports Retour à la page Publications >>
La prise en charge de la dépendance des personnes âgées à domicile : dimensions territoriales des politiques publiques
Solène Billaud, Cécile Bourreau-Dubois, Agnès Gramain, Helen Lim, Florence Weber, Jingyue Xing
Rapport MIRE/DREES sur la partie monographique de l'enquête Territoire, 2012 (mise en ligne : 2013)
The “Handicap and Dependence” seminar series is jointly organised by the researchers in the Medips project (directed by Florence Weber) and the Modapa project (directed by Agnès Gramain). The objective of this seminar series is to bring together researchers in social sciences interested by the challenges involved in public management of dependence and handicap in society. The seminars take place once a month, on a Thursday, from 17:00 to 18:30, at the Jourdan campus (48 boulevard Jourdan, 75014 Paris).
The seminars are generally in French.

The MODAPA research project brings together faculty, PhD students and research engineers who share their knowledge of the field, the data available or to be collected, and their experience in econometric methods.


Scientific coordinators
agnès gramain Agnès Gramain is a Professor of Economics at the University of Lorraine (France), and a member of the Bureau for Economic Theory and Applications (Bureau d'Economie Théorique et Appliquée, UMR 7522 / CNRS) research lab.
Research themes: health economics (long term care), social policies (support for the unemployed), and public policy interventions (decentralisation, evaluation of public policies).
cécile bourreau-dubois Cécile Bourreau-Dubois is a Professor of Economics at the University of Lorraine (France), and a member of the Bureau for Economic Theory and Applications (Bureau d'Economie Théorique et Appliquée, UMR 7522 / CNRS – Université de Lorraine) research lab.
Research themes: public economics, economics of social policies, economics of family and labour laws.
Researchers
Louis Arnault
Louis Arnault is a post-doctoral research fellow in health economics at the University Paris-Dauphine (LEDa-LEGOS). He is part of the French team that is currently undertaking the Survey of Health, Ageing and Retirement in Europe (SHARE). He defended his PhD in 2015, under the supervision of Pr. Jérôme Wittwer.
Thesis subject: the role of the entourage and the effect of public policies on the care of dependent elderly persons in France.
Christian Bontemps
Christian Bontemps is a Director of Research at the Ecole Nationale de l'Aviation Civile (ENAC) and at the Toulouse School of Economics (TSE).
Research themes: econometrics, statistics, economic theory.
Roméo Fontaine
Roméo Fontaine is an Assistant Professor at the University of Bourgogne, researcher at the Laboratoire d'Economie de Dijon (LEDi, UMR 6309 / CNRS – Université de Bourgogne), and associate researcher at the Fondation Médéric Alzheimer.
Research themes: economics of health and dependence, economics of the family.
Robin Hege Robin Hege is a doctoral candidate at the Centre d'Economie de la Sorbonne (UMR 8174 / CNRS – Université de Paris 1 Panthéon-Sorbonne) under the direction of Agnès Gramain.
Thesis subject: impact of the form of public policy on the care of elderly people with disabilities.
Helen Lim

Helen Lim has a PhD in economics from McGill University (Montreal, Canada). She has taught at various universities as adjunct lecturer, and is currently a researcher on contract with the University of Lorraine.
Quitterie Roquebert Quitterie Roquebert is a doctoral candidate at the Paris School of Economics (UMR 8545 / CNRS – Université de Paris 1 Panthéon-Sorbonne) under the direction of Lise Rochaix and Jérôme Wittwer.
Thesis subject: professional home care for dependent elderly persons living at home - territorial challenges and their effects on the care of beneficiaries.
Marianne Tenand
Marianne Tenand is a doctoral candidate at the Ecole d'économie de Paris and the Ecole normale supérieure (UMR8545 / PSE – ENS) under the direction of Pierre-Yves Geoffard and Agnès Gramain.
Thesis subject: effects and challenges of public policies for the management of dependence amongst the elderly.
Jérôme Wittwer
Jérôme Wittwer is a Professor of Economics at the University of Bordeaux and carries out his research activities at the Institut de Santé Publique d'Epidémiologie et de Développement (ISPED).
Research themes: long term care, the demand for health insurance.
Jingyue Xing
Jingyue Xing is a doctoral candidate at the Centre Maurice Halbwachs (UMR 807 / ENS - EHESS - CNRS) under the direction of Agnès Gramain and Florence Weber.
Thesis subject: governing by the distribution of public funding instruments, the pricing of establishments and providers of home care and support services for the elderly and disabled adults.