Comments from France on the 2014 Commonwealth Fund Survey

on Older Adults

Pr Isabelle Durand-Zaleski

Key findings

High population coverage by statutory health insuranceLowest cost related access problemsChronic conditions are covered 100% by the SHI

Access:Best same-day access to careLow ER visitsLow waiting times

CoordinationPatients do not perceive the lack of coordinationBut report gaps between hospital and out of hospital care

The paradoxes

Very good patient doctor relationship but no lifestyle or end-of-life discussionStatutory health insurance funding (health care) disconnected from social care funding: results in Excellent access to physicians and health care Poor coordination and limited task shifting between health and social care

Access to care

8/10 adults over 65 report a chronic conditionLow number of physician encounters and prescription drugsIn France year 80 is the year of living dangerously, ie, cutoff age for:ER admissionsHome services

Health and social care expenditures are doubled between 80 and 90 years

Yearly healthcare expenditures by person by age group

Sources : 2008 et PMSI SSR CNSA ; DREES , HCAAM.

0 €

1 000 €

2 000 €

3 000 €

4 000 €

5 000 €

6 000 €

7 000 €

8 000 €

9 000 €

10 000 €

11 000 €

0-4ans

5-9ans

10-14ans

15-19ans

20-24ans

25-29ans

30-34ans

35-39ans

40-44ans

45-49ans

50-54ans

55-59ans

60-65ans

65-69ans

70-74ans

75-79ans

80-84ans

85-89ans

90-94ans

95 anset +

SdV hors AIS

Hôpital

AIS

Etablissements et services médico-sociauxMedico- social care

nursing

hospital

Out of hospital care

ER admission, by agesource HCAAM

RAC après AMO en soins de ville et soins hospitaliers, par habitant, en 2008

0 €

100 €

200 €

300 €

400 €

500 €

600 €

700 €

800 €

900 €

1 000 €

1 100 €

0-4ans

5-9ans

10-14ans

15-19ans

20-24ans

25-29ans

30-34ans

35-39ans

40-44ans

45-49ans

50-54ans

55-59ans

60-64ans

65-69ans

70-74ans

75-79ans

80-84ans

85-89ans

90-94ans

95-99ans

100ans et

+

SdV Hôpital

RAC brut moyen : 469€

In reality, access to care is not so good:bars represent the amount of out-of-pocket expenditures for health

Sources : CNAMTS, EGB 2008 ; PMSI MCO 2008, PMSI HAD 2008, RIM P 2008 et PMSI SSR 2008.Calculations by : secrétariat général du HCAAM

Out-of-pocket expenditures by person

Average = 470€

Out of hospital

hospital

Patient engagement and end-of-life planning

Satisfaction with patient-doctor relationship: French patients can choose their physicianOpponents of the health reform law currently discussed at the Parliament suggest that freedom of choice might be curtailed

End of life:Political and contentious All religious leaders have opposed the end-of-life law

Coordination

Despite patients’ perceptions, the lack of coordination for older adults is repeatedly pointed to as a weakness in FranceThe PAERPA experiments (care pathways for persons at risk of loss of autonomy) are designed at the local level to specifically address the needs of fragile elderly

Conclusion

Perception from patients about access and care coordination is reassuringReality might be less bright, particularly for patients over age 80