Testing for fragility: a valuable public policy and an opportunity for postal operators

Because of population aging, dependency represents a major societal challenge. While some of the issues including insurance design and the provision of Long-Term-Care have recently been studied and debated, the potential role of prevention has been mostly neglected. To fill this gap the World Health Organization advocates deploying throughout the territories a systematic approach to the prevention of loss of autonomy called ICOPE (Integrated Care for Older People). It involves several stages, starting with testing and screening individuals for their risk. These screening tests use simple tools and can be performed by persons who are not health professionals. But the deployment, management, evaluation of testing requires a large human infrastructure throughout the whole territory. The national postal operators through their ability to reach each citizen at home, thanks to their large human network and the bonds of trust forged over decades between the population and mail carriers, may provide a significant contribution to the screening stage. To study the economic foundations of this approach, we present a simple model, assuming that a certain proportion of the relevant age group is screened at some cost for their dependency risk. The individual risk is measured by an exogenous parameter, which along with the individual specific expenditures on prevention, determines their probability of dependence. Screening makes it possible to target prevention according to the individual risk. Prevention reduces the probability of dependence and its cost by reducing its severity or delaying its onset. The cost of dependence includes that of formal and informal care. We determine the optimal levels of expenditures on screening and prevention to maximize welfare subject to a budget constraint. The budget constraint requires that total (expected) expenditures on screening, prevention and on the care of dependent persons equal a given budget. Determining the optimal policy involves a tradeoff between screening and prevention on the one hand and caring for dependent individuals on the other hand. Our analysis provides a precise description of costs and benefits of testing and of providing preventive care. We present and discuss the conditions under which a universal testing program is desirable.