L'assurabilité de la dépendance et sa prise en charge par le secteur privé. Une mise en perspective internationale

Since aging will probably cause a sharp increase in the demand for long-term care in the coming decades, in the numerous countries where Social Security does not recognize dependence on long-term care as a general risk of life, private insurance may provide long-term care for those who do not qualify for means-tested benefits. However private insurance for long-term care raises several difficulties: some of them (moral hazard, adverse selection) stem from information asymmetries. But the most serious difficulties are caused by long-term uncertainties: it is not clear whether the long-term care aggregate risk (especially unit costs) can be reasonably predicted. As a response to these difficulties, long-term care policies never pay the full cost of care. The coverage mostly consists of fixed nominal annuities and is exclusively dedicated to high care levels. This allows insurance companies to prevent moral hazard and to transfer the risk ? caused mainly by the uncertainty on future aggregate costs ? on policy holders. These limitations may be a rationale for not purchasing private long-term care insurance even in countries where welfare programs only provide means-tested benefits. In the United States, the number of policy holders remains low despite the enforcement of strong regulations that upgrade the quality of private insurance products. One is therefore led to consider other possible organizations for the long-term care insurance market, or the possibility for the government to recognize dependence on long-term care as a new risk financed by Social Security. Classification JEL : D80, G22, H50, I11