Comments from France on the 2014 Commonwealth Fund Survey on Older Adults Pr Isabelle...
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![Page 1: Comments from France on the 2014 Commonwealth Fund Survey on Older Adults Pr Isabelle Durand-Zaleski.](https://reader034.fdocuments.us/reader034/viewer/2022050714/56649eeb5503460f94bfcc58/html5/thumbnails/1.jpg)
Comments from France on the 2014 Commonwealth Fund Survey
on Older Adults
Pr Isabelle Durand-Zaleski
![Page 2: Comments from France on the 2014 Commonwealth Fund Survey on Older Adults Pr Isabelle Durand-Zaleski.](https://reader034.fdocuments.us/reader034/viewer/2022050714/56649eeb5503460f94bfcc58/html5/thumbnails/2.jpg)
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
![Page 3: Comments from France on the 2014 Commonwealth Fund Survey on Older Adults Pr Isabelle Durand-Zaleski.](https://reader034.fdocuments.us/reader034/viewer/2022050714/56649eeb5503460f94bfcc58/html5/thumbnails/3.jpg)
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
![Page 4: Comments from France on the 2014 Commonwealth Fund Survey on Older Adults Pr Isabelle Durand-Zaleski.](https://reader034.fdocuments.us/reader034/viewer/2022050714/56649eeb5503460f94bfcc58/html5/thumbnails/4.jpg)
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
![Page 5: Comments from France on the 2014 Commonwealth Fund Survey on Older Adults Pr Isabelle Durand-Zaleski.](https://reader034.fdocuments.us/reader034/viewer/2022050714/56649eeb5503460f94bfcc58/html5/thumbnails/5.jpg)
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
![Page 6: Comments from France on the 2014 Commonwealth Fund Survey on Older Adults Pr Isabelle Durand-Zaleski.](https://reader034.fdocuments.us/reader034/viewer/2022050714/56649eeb5503460f94bfcc58/html5/thumbnails/6.jpg)
ER admission, by agesource HCAAM
![Page 7: Comments from France on the 2014 Commonwealth Fund Survey on Older Adults Pr Isabelle Durand-Zaleski.](https://reader034.fdocuments.us/reader034/viewer/2022050714/56649eeb5503460f94bfcc58/html5/thumbnails/7.jpg)
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
![Page 8: Comments from France on the 2014 Commonwealth Fund Survey on Older Adults Pr Isabelle Durand-Zaleski.](https://reader034.fdocuments.us/reader034/viewer/2022050714/56649eeb5503460f94bfcc58/html5/thumbnails/8.jpg)
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
![Page 9: Comments from France on the 2014 Commonwealth Fund Survey on Older Adults Pr Isabelle Durand-Zaleski.](https://reader034.fdocuments.us/reader034/viewer/2022050714/56649eeb5503460f94bfcc58/html5/thumbnails/9.jpg)
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
![Page 10: Comments from France on the 2014 Commonwealth Fund Survey on Older Adults Pr Isabelle Durand-Zaleski.](https://reader034.fdocuments.us/reader034/viewer/2022050714/56649eeb5503460f94bfcc58/html5/thumbnails/10.jpg)
Conclusion
Perception from patients about access and care coordination is reassuringReality might be less bright, particularly for patients over age 80