An Analysis of the Public Financial Support Eligibility Rule for French Dependent Elders with Alzheimer’s Disease

• Published in: Value in health Vol. 18; no. 5; pp. 553 - 559
• Main Authors: Rapp, Thomas, PhD, Lacey, Loretto, PhD, Ousset, Pierre-Jean, MD, Cowppli-Bony, Pascale, MD, PhD, Vellas, Bruno, MD, PhD, Orgogozo, Jean-Marc, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2015
• Subjects: Aged; Alzheimer Disease - diagnosis; Alzheimer Disease - economics; Alzheimer Disease - therapy; Alzheimer’s disease; Caregivers - economics; Cost of Illness; Cross-Sectional Studies; Delivery of Health Care - economics; dependence; Eligibility Determination - economics; Female; France; Health Expenditures; Health Services Needs and Demand - economics; Humans; informal care; Insurance, Health - economics; Internal Medicine; Interviews as Topic; Male; Medical Assistance - economics; Models, Economic; National Health Programs - economics; Needs Assessment - economics; Patient Care - economics; Public Sector - economics; Surveys and Questionnaires; Time Factors; France; Alzheimer’s disease; informal care; dependence
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2015.03.1785

Abstract Background It is crucial to define health policies that target patients with the highest needs. In France, public financial support is provided to dependent patients: it can be used to finance informal care time and nonmedical care use. Eligibility for public subsidies and reimbursement of costs is associated with a specific tool: the autonomie gérontologie groupes iso-ressources (AGGIR) scale score. Objective Our objective was to explore whether patients with Alzheimer’s disease who are eligible for public financial support have greater needs than do noneligible patients. Methods Using data from the Dépendance des patients atteints de la maladie d’Alzheimer en France study, we calculated nonmedical care expenditures (in €) using microcosting methods and informal care time demand (hours/month) using the Resource Use in Dementia questionnaire. We measured the burden associated with informal care provision with Zarit Burden Interview. We used a modified two-part model to explore the correlation between public financial support eligibility and these three variables. Results We find evidence of higher informal care use, higher informal caregivers’ burden, and higher care expenditures when patients have an AGGIR scale score corresponding to public financial support eligibility. Conclusions The AGGIR scale is useful to target patients with the highest costs and needs. Given our results, public subsidies could be used to further sustain informal caregivers networks by financing programs dedicated to lowering informal caregivers’ burden.