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

Résumé En Fr

Is the risk of dependence on long-term care insurable? An international survey 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. 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.

Afin de pallier l'augmentation probable de la demande de soins de longue durée et les insuffisances de la couverture publique dans les nombreux pays où la dépendance n'est pas reconnue comme un risque normal de l'existence par la Sécurité sociale, l'assurance privée semble être en mesure de jouer un rôle important dans la couverture des personnes n'ayant pas accès aux prestations attribuées sous conditions de ressources. L'assurance dépendance rencontre cependant un certain nombre de difficultés : d'une part, les difficultés « habituelles » de l'assurance (aléa moral, antisélection) ; d'autre part, l'assurance dépendance se heurte à des incertitudes majeures quant à l'évolution tant des probabilités d'entrée en dépendance que du coût unitaire des soins et aides de longue durée. En réponse à ces incertitudes, les assureurs proposent généralement des polices qui limitent leur exposition au risque en en reportant une part importante sur les assurés : la quasi-totalité des contrats prévoit ainsi des prestations forfaitaires qui ne sont versées qu'en cas de dépendance très lourde. Ces limites fournissent peut-être une explication rationnelle au faible développement de l'assurance privée, y compris dans des pays où les prestations publiques se limitent à une aide sociale attribuée sous conditions de ressources. Ainsi aux États-Unis, malgré l'intervention des pouvoirs publics qui ont régulé le marché de manière à améliorer la qualité des produits, le nombre de souscripteurs demeure faible. Ceci amène à considérer des modes alternatifs d'organisation du marché de l'assurance dépendance, voire une reconnaissance par l'État de la dépendance comme un nouveau risque couvert par la Sécurité sociale.