In a thematic synthesis, the Institute for Research and Documentation in Health Economics (Irdes) looks at the disparity in nursing home accommodation costs between for-profit and non-profit establishments. What emerges is a lack of correlation between cost and quality of care.
Accommodation establishments for dependent elderly people (Ehpad) offer support for carrying out daily activities, medical care and accommodation. Support and care are financed by the National Solidarity Fund for Autonomy (CNSA) and the departments, while the cost of accommodation is paid by residents. The price of accommodation in nursing homes varies between establishments from 1,400 euros to more than 6,000 euros per month, with rates more expensive in establishments belonging to the private for-profit sector than in public or private non-profit establishments. The economic sector of nursing homes is also characterized by very different competitive contexts in the territory. On the one hand, certain departments are significantly better equipped than others with accommodation places and, on the other hand, the lucrative private sector represents in certain departments half or more of the places available, although it can be very minority elsewhere.
This study, thanks to an original matching of data from different sources (National Health Data System (SNDS), Directorate of Research, Studies, Evaluation and Statistics (Drees) and National Solidarity Fund for autonomy (CNSA)), relates accommodation prices to different dimensions of quality (characteristics of premises, support for residents, care, etc.) and the local competitive context. The two main price determinants are the location of the nursing home and the lucrative private legal status. On the other hand, higher accommodation prices are generally not associated with better quality. In addition, the prices of lucrative private establishments are all the higher as the share of the non-profit sector is lower; This greater market power of the lucrative sector is also accompanied by a higher frequency of hospitalizations of residents in these establishments (30-day readmissions, potentially avoidable hospitalizations, unscheduled hospitalizations), which questions the quality of the care provided.
• The most expensive nursing homes are not the bestAnne Penneau and Zeynep Or, Health economics questions n°295December 2024, Irdes.
