Dependency : the track of a new day of solidarity

Demonstration in Quimper against the lack of resources in the long-term care Facility, on January 30, 2018. Agnès Buzyn has promised to freeze the effects of the reform of the pricing of these facilities for the dependent elderly decided by the former majority.

© FRED TANNEAU / AFP

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Emmanuel Macron was confirmed Sunday evening, during his interview by Jean-Jacques Bourdin and Edwy Plenel. The head of the State wants better funding for addiction in order to ” better support the loss of autonomy of elderly people.

In 2011-2012, in the midst of economic crisis, French president Nicolas Sarkozy had retreated before the obstacle, after having promised the creation of a fifth branch of social Security, in the same way as accidents at work, sickness, pensions and family.

We will need to build a sustainable funding.

François Hollande had then been only modest changes in 2016, having also promised a reform of ltc in its 60 commitments of the campaign.

Emmanuel Macron will go there until the end ? Part of the problem is financial. To take better care of the dependency, it will have to find new ways. According to projections, France will have more than 5 million people aged over 85 years (the people who are most often dependent) in 2050, compared with 1.5 million today.

“We will need to build a sustainable funding, which does not exist today. (…) It will have to go and fetch the money, “admitted the president, before adding :” It is the national community that is going to have to take this funding support. “

The day of solidarity, a decline in the purchasing power ?

His minister of Health, Agnes Buzyn, is working on a number of assumptions. Among these is the introduction of a new Pentecost Monday, that is to say, in reality, an extra day worked in the year, but who is not paid to the employee. Contributions would go to funding dependence, as decided by Jean-Pierre Raffarin under the presidency of Jacques Chirac in 2004. This “track” has been deemed interesting by Emmanuel Macron. “It is unfair and far from being up to the challenges. The effort of funding needed cannot be supported exclusively by the employees (this would equate to a decline in the purchasing power of 0.3 %) “, replicates the CFDT in a press release Monday.

The president has also suggested, such as Nicolas Sarkozy, at the time, that this could be achieved by the creation of a fifth branch of social Security. “This is a new risk that we need to build “, he explained, before discussing the ” mechanisms of social security “.

Roadmap by the end of April

The minister of Health seems, however, to postpone the solution of a compulsory insurance, which would require an increase in contributions and thus the cost of the work. “It’s part of the track proposed by some, I’m not too favorable to the insurance model,” assured Agnès Buzyn on RMC and BFM TV on April 12. For the CFDT, the risk of dependence would have to be ” funded primarily by the taxes allocated based on all income (including all estates), like the CSG. But the government itself is deprived of this possibility by increasing the CSG pensioners to fund… the unemployment insurance “.

The minister has not the air no longer excited by the hypothesis of the use of private insurance, to which the assets themselves could contribute. Agnès Buzyn prefer to explore a pooling of funds with the health Insurance that would mix the ” part addiction and part care in a single envelope “. Currently, the money devoted to the care of dependent people is indeed separate from that allocated to the loss of autonomy to speak of, which is distributed by the departments via the allocation personnalisée autonomy (APA). “The multiplicity of regulators and the logic of funding makes it difficult to put in place a comprehensive policy “, regretted the economic analysis Council (CAE) in a ratio of 2016.

Agnès Buzyn has promised that it would submit a roadmap by the end of April ” and solutions by the end of the year.

As at 31 December 2015, the number of beneficiaries of the allocation personnalisée autonomy was of 1 265 000 people, of which :

– 748 000 people living in the home ;

– 517 000 persons living in an institution.

Public expenditure on the dependence accounted for 23.5 billion euros in 2011 on a total of 45 billion, according to the report of the Council of economic analysis of 2016. Public spending goes through the care devoted to dependent persons, through the health insurance branch of social Security. In 2014, this amounted to 12 billion euros, according to the CAE. The rest is distributed by the departments in the form of an allowance custom of autonomy (APA), which depends on the degree of dependency of the person, its resources and the type of care : home care or transfer to an establishment accommodation for dependent elderly people (Ehpad). In 2014, it cost a little less than 6 billion euros. Finally, a billion euros are financed via tax reductions (for example, for the employment of a person in the home). The remainder of the envelope comes directly from the pocket of the households concerned, who sometimes have to pay remains to support very important, inter alia, the “accommodation” stays in long-term care facilities. “In 2011, more than one in two residents had a cost greater than its resources,” noted the CAE. “In the institution, it is for the middle-income (between 1 200 and 1 800 euros monthly) who are not receiving either social assistance or tax reductions that the public support is the lowest “, added in 2011, the economic Council, social and environmental in a report.

On the revenue side, a large part of it comes from the health insurance. On the day of solidarity, she has reported 2.3 billion euros in 2017. The French were also an additional contribution of solidarity for autonomy (Casa) charged at the rate of 0.3 % on pensions, gross disability pensions and pensions for early retirement (about 750 million euros).

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