Comments from France on the 2014 Commonwealth Fund Survey on Older Adults Pr Isabelle Durand-Zaleski

Key findings High population coverage by statutory health insurance Lowest cost related access problems Chronic conditions are covered 100% by the SHI Access: Best same-day access to care Low ER visits Low waiting times Coordination Patients do not perceive the lack of coordination But report gaps between hospital and out of hospital care

The paradoxes Very good patient doctor relationship but no lifestyle or end-of-life discussion Statutory 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

Access to care 8/10 adults over 65 report a chronic condition Low number of physician encounters and prescription drugs In France year 80 is the year of living dangerously, ie, cutoff age for: ER admissions Home services Health and social care expenditures are doubled between 80 and 90 years

Yearly healthcare expenditures by person by age group Sources : 2008 et PMSI SSR CNSA ; DREES, HCAAM. Medico- social care nursing hospital Out of hospital care

ER admission, by age source HCAAM

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 Calculations by : secrétariat général du HCAAM Out-of-pocket expenditures by person Average = 470€ Out of hospital hospital

Patient engagement and end-of-life planning Satisfaction with patient-doctor relationship: French patients can choose their physician Opponents 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

Coordination Despite patients’ perceptions, the lack of coordination for older adults is repeatedly pointed to as a weakness in France The 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

Conclusion Perception from patients about access and care coordination is reassuring Reality might be less bright, particularly for patients over age 80