Insurability and development of LTC insurance.

Summary LTC insurance for the elderly is an enigma in France and in many other developed countries (United States, Spain, etc.). Why has the LTC insurance market not developed further, when LTC represents a very significant financial risk for the elderly and public assistance is very inadequate in most countries? This thesis proposes an original study of the LTC market and provides a new answer to this enigma. It studies whether the market rationing is explained by reasons related to the functioning of markets (explanations most often retained by the literature) or whether this sub-optimal equilibrium is the result of more institutional reasons. This research leads to four results. In the first part, it shows, on the basis of original data, that it is possible to push back the frontier of insurability for LTC risk, particularly for home care. In the second part, we show that individual preferences may lead some agents not to insure themselves for at least two reasons: either because the product offered is not a fully insured product or because their actual or anticipated health status has a very strong effect on the valuation of their wealth. We also have a portfolio of insured individuals. The results obtained from these data, never before available in France, indicate that the LTC contract is destined to become a mass product, particularly appreciated by the working and middle classes. Finally, in the third part, standard tests conclude from our data that there is no anti-selection in the French LTC insurance market. This absence of anti-selection could be explained by compensation phenomena. From these four results, we can argue that the weak development of the French LTC insurance market is not explained by a market failure in the coverage of this risk but by more contextual and institutional reasons (criteria for the allocation of public aid, disadvantageous taxation compared to insurance contracts, etc. . ). However, a part of the population, because of its preferences, will rationally continue not to insure itself.