Nov 14, 2020 in Health

Long-term Care in France verses United States

Long-term care in France verses United States

Long-term care can be defined as the care for people who need support in many aspects of living over a long period. It refers to the help provided including activities of daily life (ADL), for instance, dressing, bathing and sleeping performed by family low-skilled caregivers or friends. Long-term care is growing but it occupies relatively small margin of the economy both in France and in the United States of America. This paper will analyze and compare the growing demand for long-term care in France and in the United States of America including percentage of people who need long-term care, the quality, barriers and the cost of provision of long-term care in the two countries.


Long-term care delivery process in France

The long-term care system in France was established by the LaRoques report that was in 1962. It focused on the economic activities of people aged above 60 years old in terms of their age and employment. Dependency of the people aged above 60 years became an issue in 1986 when the Braun report was published. Trial solutions were established at the local (departmental) levels. The first allowance for frail or dependent elderly people was established in 1997. By 2008, there were approximately 106,000 home nursing care places in France. By 2011, 16.9 percent of Frances population was 65 years old and another 5.5 percent was over 80 years old. As in most European nations, long-term care focuses on the elderly and in France constitutes people of 60 years of age and above. Therefore, theoretically they constitute eligibility for long-term care. Thus, by 2011, 22.4 percent of the whole population in France needed long-term care (Kessler, 2008).

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Long-term care delivery process in the U.S.A

Elderly Americans make up the only group of population that has universal healthcare insurance as an entitlement. The U.S. Department of Health reports that 70 percent of people, who are 65 years and above of age will need long-term care in their lives even if it is not immediately. In America, over 10 million people have purchased the long-term care insurance. It makes up the number within 27.3 percent of people who need long-term care.

Comparison in terms of quality of care and

what barriers are there to providing the quality of care

In France, the quality of long-term care is high. The public coverage of long-term care is founded on the tradition of intervention of social assistance and the diversity of actors and sources of financing. The long-term care plan is highly organized in France. For example, at the national level, the sickness insurance scheme is specifically meant for expenses of healthcare. The retirement insurance provision finances the living expenses through domestic assistance. At the regional level, the general councils have mandate on Personalized Allowance Autonomy (APA) that is paid to people of the age of 65 or above that are not autonomous irrespective of their geographical or financial situations. Private insurance has also been established in terms of individual or collective coverage that assures the payment of a fixed allowance monthly depending on the degree of dependency.

The main challenge with long-term care in France is associated with the fact that different regimes have interfered with health care reform. In addition, there is a perceived issue of uneven quality in the distribution of long-term care services and a list of long-term care homes that offer low-quality care. Long-term care in France is high in terms of spending (Blomqvist & Busby, 2012).

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In the U.S., the nursing home care as well as other long-term care plans is heavily regulated in the economy. The sector is controlled by a regulatory system that involves interplay of voluntary, state and federal rules and regulations that monitor the quality of homes and other community-based services provided. The quality of care in the U.S. started improving when Medicare reimbursed post-hospital nursing home and home care and when Medicaid established a paying program for nursing homes. However, monitoring what exactly goes on in the long-term care facilities has been a challenge in the U.S.

The main challenges of the long-term care in the U.S. deal with issues of linking functional tasks of daily living and understanding the demographic changes anticipated to shape the long-term delivery care in the future (Hussain & Rivers, 2009).

What is the cost and who pays for LTC (France vs. US)?

In France, the Personalized Allowance of Autonomy (APA) is responsible for the payment of long-term care. The allowance is paid both by the central and regional governments. The retirement insurance scheme finances part of the living expenses by means of domestic assistance. The cost of long-term care is not too expensive. For instance, in 2008, it was about 1.8 percent of the national Gross Domestics Product (GDP).

In the U.S., on the other hand, costs of long-term care are paid by the elderly themselves and when they are unable, the Medicaid program does it and it accounts for about 22 percent of the national primary long-term care plan. One third of Medicaid funds is used for elderly and people with disabilities. In the U.S., the cost of long-term care is relatively expensive. However, the costs vary according to state (Gleckman, 2010).

What is uncompensated care?

Uncompensated care is the total sum of health care services that are provided to people based on the established cost to people unwilling or unable to pay. It includes bad debt and charity care (Graves, 2012).

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Summary and conclusions

This analysis has revealed two major findings about the long-term care in France and USA. First, long-term care in France is highly organized and involves government deeply both at the central and regional level. Secondly, in the U.S., long-term health care is left for people to sort out by themselves and the government comes in only when people who need it cannot afford to pay for it. The U.S. can learn from France on how to organize health care plan so that those who need it or may need it plan early on how to pay for it; for instance, through retirement schemes or proper government support as opposed to support when people are already in the stage where they need it and cannot pay for it. The U.S. needs adequate planning for future long-term care needs.


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