JUIN Sandrine

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To what extent would elderly Europeans be able to finance the expenses related to their loss of autonomy from their income and wealth alone, in the absence of informal assistance and public insurance? To answer this question, we develop a microsimulation model and estimate, using data from the SHARE (Survey of Health, Ageing and Retirement in Europe) survey, the dependency trajectories of people aged 65 and over in nine European countries. We pay particular attention to the potential role of lifetime mortgages as a tool for extracting value from real estate. According to the simulations, 57% of people aged 65 and over will face a loss of independence. For them, the average duration of dependency will be 4.4 years. Among the dependent people without a spouse, 6% would be able to cover their expenses for loss of autonomy thanks to their income alone, a figure that rises to 22% if they mobilize all of their assets, except their home. This proportion would double to 49% if these people took out a life mortgage on their main residence. However, a quarter of them would only be able to finance less than 10% of their expenses for loss of autonomy.

In the context of a rapidly aging population, this doctoral dissertation explores the relationship between health and long-term care arrangements and addresses the issue of the financing of long-term care.Meeting the needs of dependent elderly is an important objective of public policy. Chapter 1 estimates the effects of both informal (i.e. family) care and formal (i.e. professional) home care on the mental health of French dependent elderly. The results highlight that informal care decreases the risk of depression and that formal care can improve general mental health.Recent studies acknowledge that providing informal care has adverse health effects and emphasize the importance of supporting caregivers. Chapter 2 examines the effect of social support on caregivers' health. It shows that formal care and informal support limit the negative consequences of caregiving on mental health.Finally, given the increasing financial and fiscal pressure on public systems, Chapter 3 investigates to what extent Europeans elderly are able to pay for their periods of long-term care needs on the basis of their income, financial assets and home equity. It also studies the role of reverse mortgages. The simulations stress that only a small proportion of individuals would be able to finance totally their long-term care expenses and that housing assets may play an important role in long-term care financing.

While theoretical models on long-term care decisions assume that the health production function of dependent elderly depends positively on the care received, it has not received much attention in the empirical literature. We estimate the effects of both informal and formal home care on the mental health of elderly individuals in France needing help with daily activities. We adjust for the endogeneity of care with instrumental variables, using characteristics of adult children and geographical disparities in access to public long-term care coverage. The results show that informal care reduces the risk of depression of dependent elderly and that formal care increases their general mental health.

In the context of a rapidly ageing population, this thesis explores the links between health and care methods for dependent elderly people and addresses the issue of financing dependence. Meeting the assistance needs of dependent elderly people is a central objective of public policy. Chapter 1 estimates the effect of informal (i.e. family) and formal (i.e. professional) home help on the mental health of dependent elderly people in France. The results show that informal help reduces the risk of depression and that formal help can improve general mental health. Recent studies recognize that helping a dependent relative has negative effects on the health of caregivers and emphasize the importance of supporting them. Chapter 2 focuses on the effect of social support on the health of informal caregivers. Finally, given the financial and fiscal pressure on public systems, Chapter 3 examines the extent to which Europeans would be able to finance their periods of dependency on the basis of their income and their financial and real estate assets. It also looks at the role of lifetime mortgages. The simulations show that only a small proportion of individuals would be able to finance all their LTC expenses. On the other hand, real estate assets could play an important role in financing LTC.

In France, the number of dependent elderly should d ouble by 2060. It is thus important to address the well-being of this growing share of the population. This work aims at estimating the effects of informal care and formal care on the mental health of dependent elderly. Furthermore, we allow the effect of care to vary de pending on the level of dependence, the gender of the dependent elderly and the relationship between the elderly and the primary informal caregiver. Many theoretical models include a production function of health which has two inputs, formal care and informal care but t his function has not been the subject of many empirical studies. In order to estimate the health production function, we use the French Disability and Health Survey (2008). Using a sample of 4,067 dependent elderly, three equations are jointly estimated by the maximum-likelihood method: mental health, informal care and formal care. Correlated residuals partially take into account the relationship between formal and informal cares and the reverse causality of mental health on care received. We use two mental health indicators: depression and the Mental-Health Inventory (MHI-5). The results show a positive effect of informal care on mental health, for slightly dependent elderly, for individuals receiving care from friends or neighbors and for men receiving care from a daughter or from siblings. Formal care decreases the risk of depression and improves the MHI-5 of elderly dependent people, this last effect being higher for women.

The main objective of this study is to analyse the effect of the professional environment on sick leaves. The professional context is approximated by the sector of activity. The database used - Hygie (2005-2008) - allows taking individual heterogeneity into account thanks to the longitudinal dimension. Sick leave probability is estimated through a fixed effects logit model and the duration (number of days absent due to sickness) is estimated through a fixed effects Poisson model. The results show that sectors of activity differ in sick leave duration rather than in the occurrence. Indeed, taking into account individual heterogeneity and differences in health status and wages reduces the variability in sick leave probability between sectors by half. On the other hand, the sector remains decisive in explaining sick leave durations. This residual variability may refer to unobserved differences in working conditions, in the generosity of daily sick pay benefits or in job insecurity.

The main objective of this study is to analyze the effect of the professional environment on sick leaves. It is important in order to identify the potential policies to implement to control health expenditures (e.g. through the improvement of working conditions). This professional context is approximated by the Business sector. The database used - Hygie (2005-2008) - allows taking into account individual heterogeneity thanks to the longitudinal dimension. Sick leave probability is estimated through an individual fixed effects logit model and the duration (number of sickness absence days) is estimated through a fixed effects Poisson model. The results show that Business sector differ in sick leave duration rather than in the occurrence. Indeed, taking into account differences in health status and wages reduces the variability in sick leave probability between sectors by half. On the other hand, the sector remains decisive in explaining sick leave durations. This residual variability may refer to unobserved differences in working conditions, in the generosity of sick pay benefits or in job insecurity. These results may call into question the financing of sick leaves, which contrary to accidents at work and professional diseases, only depends on social security contributions.