Why care about who pays for care? Horizontal inequity in home care use for older adults

As populations age, a growing number of people need help with everyday activities. Long-term care can be provided by professional caregivers; however, the associated costs can lead to horizontal inequity, i.e. unequal access to care for individuals with similar needs. This paper examines income-related horizontal inequity in home care use in France, and the effects on horizontal inequity of the three funding systems involved: national health insurance, government allowances, and income tax deductions. Results reveal income-related inequities that favour wealthier individuals. Furthermore, while all three systems (including national health insurance) lead to horizontal inequity, we find that half of this inequity comes from home care provided by professionals funded directly by income tax deductions.