ANR JCJC (2024-2027)
Healthcare needs in France are expected to grow in the next few decades. Aging population, an increase in diseases due to sedentary and poor health behavior (France is one of the European countries with the highest alcohol and tobacco consumption), a shortage of doctors, and the growth of treatment costs associated with innovation are expected to put pressure on the rise of healthcare expenditure. These major issues require a better understanding of how and why healthcare expenditure (HCE) evolves to better anticipate future healthcare needs. Evidence from foreign countries are hardly transposable to the French case, and little is known about the factors of HCE growth in France. Moreover, how these growth factors vary across time is still unknown. The factors driving HCE growth most of the time let aside the role of supply and demand. Thus, little is known, for example, about the impact of doctor shortage on HCE; whether telemedicine addresses medical desert issues; or how public policies can affect HCE.
DynamicsHealth aims to take advantage of the French administrative data that covers exhaustively every health care use for all French residents, to develop a pioneer and comprehensive analysis of how HCE evolves in France and to explain the reasons for these changes on the supply and demand sides. The main objectives are to: (i) describe the evolution of care over 16 years and understand the role of aging, technology, morbidity, and economic factors; (ii) identify the causal impact of supply variation on HCE. I will focus on the closure of doctors' practices and the arrival of new types of supply, such as telemedicine. (iii) Understand how public policies can modify the demand for healthcare by other levers than price. The role of having access to care through or under an insured (child under his parent and spouse under his wife) will be of particular interest because it highlights the role of confidentiality rules on healthcare demand.
Horizon grant (2023-2027)
Join with: Max Planck Institute & Munich Research Institute for the Economic of Ageing; Bruegel; University Carlos III Madrid; Royal Institution for the Advancement of Learning McGill University;
The baby boomers are in the process of retiring. Most are between 60 and 65 when they retire and almost 80% self-assess their health as good. A huge number of research projects has analyzed retirement decisions and the impact of this “pension wave” on the transformation of pension systems in the ageing societies in Europe and elsewhere. There is no lack of pension finance projections and policy advice for pension reforms and their socio-economic effects, including active ageing and the role of elder citizens in transforming our economies into “silver economies”.
Much less is known about the second great transformation that will follow the pension wave. In the mid2030s, the health of the baby boomers will have deteriorated and many in these large cohorts will be in need of formal and/or informal long-term care. This “care wave” will transform two generations: the baby boomers in need of care and their children who may supply care. It will have significant implications for labour supply, especially for women, saving behaviour, and therefore for productivity, economic growth and its inclusiveness.
The overarching objective of BB-Future is to make a concerted effort to understand the size and the implications of the care wave on economic and social outcomes, to appreciate the quality of this second ageing-related transformation and to develop policy recommendations for advance planning on the EU and MS levels.
"Impact of Physician Practice Closure on Patients' Healthcare access and use" with Daniel Herrera and Thibaut Heyer
Abstract: Physician practice closures can disrupt healthcare access and utilization through multiple channels, including changes in prescription behavior by replacement physicians, breaks in continuity of care, increased difficulty in securing a new provider, higher searching cost and travel cost for patients, and longer waiting times for remaining practitioners. This paper provides the first comprehensive analysis of the effects of general practitioner (GP) departure on both directly affected patients and indirectly affected patients who experience spillovers due to increased demand on their physicians. We leverage an exhaustive French administrative health data to implement an event-study and difference-in-differences framework. We find that GP practice closures lead to a persistent decline in visits to general practitioners among affected patients, without a compensating increase in specialist consultations, hospital admissions, or medical imaging. We detect no evidence of spillover effects on other patients of neighboring physicians. Finally, while heterogeneity by physician characteristics is limited, we document larger effects among younger patients with chronic conditions, suggesting a larger vulnerability to disruptions in primary care continuity.
"Informal Care and Migration Background in Europe" with Violette Dollé and Florence Jusot
Ageing in a country of residence different from one’s country of birth (i.e., following migration) may significantly influence patterns of informal care provision. While childcare among migrant is well documented, comparatively little is known about care toward elderly parents and other kin for household tasks, personal care and administrative assistance. This study examines how migration background relates to informal care provision in Europe, distinguishing different types of tasks, recipients, and intensities of care. Using longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE) from 2015 to 2025, our standardisation method and Oaxaca-Blinder decomposition show difference between native and migrant but also heterogeneity depending on age at migration. Individuals who migrated during childhood exhibit a higher likelihood of providing support, whereas those who migrated during adulthood are less likely to engage in such activities. These differences persist after accounting for compositional factors including geographic proximity, socioeconomic characteristics, and health status. Our findings highlight the importance of considering early-life migration experiences when analysing informal care patterns and suggest the need for further research into the mechanisms that drive these disparities.
"Maternity Leave and Family Ties ove the Life Cycle" with Romane Frecheville
Abstract: The aim of this paper is to document the impact of maternity leave on family ties. Family ties is a key determinant of informal care over the life cycle. Thus, public policies affecting maternity leave might affect not only childcare arrangement but also elderly care arrangement later in life. We use eleven countries of the survey on health ageing, retirement in Europe (SHARE). We analyse the impact of maternity leave on distance to parent, emotional closeness and informal care provision. Because of reverse causality issues, we use changes in legal maternity leave duration in Europe between 1970 and 2000 as an instrumental variable. We find that maternity leave increases the probability of living further from their parents, but do not affect emotional closeness to parents, nor probability of providing care to their elderly disabled parents. This paper bridge a gap in the literature on the impact of maternity leave, and inform policy makers that while maternity leave does not seems to affect the probability of providing informal care, it might affect the burden of caregiver by increasing their distance to care-receiver.
"Why Care about Who Pays for Care? An Analysis of Horizontal Inequity in Formal Care Use" with Clémentine Garrouste and Florence Jusot
Abstract: The ageing population has led to an increasing number of individuals who need help with daily activities. These long-term care (LTC) needs can be provided by professional caregivers. However, accessing such services can be costly and a source of horizontal inequity, i.e. unequal access to care for individuals with similar needs. This paper examines income-related horizontal inequity (HI) in formal care use in France, and the role of three funding systems in HI: National Health Insurance, allowance and income tax deduction. Our findings reveal income-related inequities favouring wealthier individuals. We find evidence that half of the inequity stems from home care provided by professionals funded directly by income tax deduction, rather than through insurance or allowance-based schemes. In addition, while inequities disappear for formal care funded jointly by insurance and subsidies, they persist when funded exclusively by the National Health Insurance.
"Severe Cognitive Impairments and Long-term Care In Germany" with Axel Börsch-Supan, Johannes Geyer, Peter Haan, and Sami Louahlia
Abstract: Germany faces growing challenges in financing long-term care (LTC) for its aging population, particularly for individuals with severe cognitive impairment (SCI). Using data from the European SHARE survey (wave 9), this study estimates the economic burden of SCI on LTC.We find that 4%of elderly individuals living at home have SCI. They are 30% more likely to receive care. On average, they use six additional hours of both formal and informal care per week. However, our analysis shows that the primary driver of increased LTC use is not SCI itself, but the resulting limitations in activities of daily living (ADLs). Once ADLs are accounted for, SCI does not independently increase care needs. The annual cost of care for individuals with SCI is estimated at €10,000 per person, compared to €5,000 for those without SCI. For nursing home residents, who have a higher prevalence of SCI, annual LTC costs reach approximately €44,000 per capita. These findings highlight the significant economic impact of SCI on LTC financing in Germany.
"Divergent Trajectories of the Deaths of Despair Burden across Subnational Regions in Europe " with Florian Bonnet, Ina Alliger, Carlo-Giovanni Camarda, Sebastian Klüsener, France Meslé, Michael Mühlichen, and Pavel Grigoriev
Abstract: While deaths of despair (DoD) have been extensively documented in the US, evidence for Europe remains scarce, particularly at the subnational level. Using cause-specific mortality data covering 170 regions from 23 countries and spanning the two decades preceding the COVID-19 pandemic, this study provides the first comprehensive subnational analysis of DoD mortality across Europe and benchmarks regional trends against the US. Our results reveal a 15% decline in the overall DoD burden across Europe. Yet this overall trend conceals deeply heterogeneous regional dynamics, with only two in three regions experiencing significant decreases. Three contiguous transnational clusters of stagnating or rising mortality emerged in the North-Western and Eastern parts of Europe, as well as in Sweden. At the end of the study period, a clear north-south gradient in DoD burden is evident, with levels in Scotland, Lithuania, and parts of Poland exceeding those observed in the US. Stratifying by age group and category of DoD reveals further concerning dynamics. Among the working-age population, steep increases in drug-related burden were observed in the United Kingdom and Sweden. Among the elderly, alcohol emerged as the dominant driver: rising mortality from acute alcohol-related causes affected one in two European regions, and from liver diseases one in three, with overall burden levels exceeding the US benchmark in half of all regions. These findings demonstrate that Europe is not immune to the forces driving deaths of despair and call for renewed subnational monitoring and regionally tailored public health responses.