Les personnes dépendantes en France : Evolution et prise en charge[Old-age disability in France: Long-term evolution, private caregiving and public expenditure]

Using the microsimulation model Destinie, we project the number of elderly disabled people by 2040 in France. Transition probabilities between three different states of disability (non-dependent, moderately dependent, severely dependent) are estimated based on data from the HID survey, a two-wave panel. Results are very sensitive to our assumptions regarding the average duration of disability. In our central scenario, in which life expectancy with disability at age 60 remains stable, 1.2 million elderly people would suffer from disability in 2040, a 50% increase compared to 2000. The average age of the disabled elderly would increase markedly, from 78 to 82 years for men, and from 83 to 87.7 years for women. The share of severely dependent elderly people would remain stable, at 41% of the total number of disabled elderly. Microsimulation also allows for a longitudinal approach. We follow individuals from generations 1940 to 1954, from their 60th birthday to their death. Women are more affected by old-age disability than men: among the individuals living beyond age 60, 52% of women and 29% of men would experience at least one year in dependency. Because of the fall in fertility and the increasing number of divorces, the average number of potential caregivers (spouse and children) will tend to decrease over the next 40 years, from 2.8 to 2.3 for men and from 2.2 to 2.0 for women. The number of disabled people without spouse nor valid child would increase from 125,000 today to 165,000 in 2040. With unchanged legislation, the annual public expenditures related to Apa (Allocation personnalisée d’autonomie, the disability allowance targeted toward elderly people) would increase from 3.5 to 4 billion euros (in constant prices) in 2040. This moderate evolution is due to the assumption of a price-indexed schedule: the maximum value of the benefit would remain stable in constant prices, and the share of this maximum value actually paid to beneficiaries would decline over time. Indeed, this share depends on household resources; even though pensions are themselves price-indexed, their average level will increase significantly due to the renewal of cohorts of pensioners. Results are markedly different if we assume an indexation of Apa on wages. Such an assumption takes a better account of likely changes in costs of caregiving to disabled people: it would lead to an annual public cost of about 10.2 billion euros in 2040.