The Journal of Socio-Economics 38 (2009) 138–146 Contents lists available at ScienceDirect The Journal of Socio-Economics journal homepage: www.elsevier.com/locate/soceco Socioeconomic determinants of the need for personal assistance reported by community-dwelling elderly: Empirical evidence from a French national health survey Bérengère Davin a,b,c , Alain Paraponaris a,b,c,∗ , Pierre Verger a,b,c a INSERM, U912 (SE4S), Marseille, France b Université Aix Marseille, IRD, UMR-S912, Marseille, France c ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d’Azur, Marseille, France article info Article history: Received 20 July 2007 Received in revised form 27 August 2008 Accepted 15 October 2008 JEL classification: I10 C35 Keywords: Elderly Impairments Need for personal assistance Andersen and Newman’s behavioral model Bivariate probit model with sample selection abstract A bivariate probit model with sample selection is used to estimate the conditional probability of reporting a need for personal assistance (NPA) with at least one activity of daily living among French community- dwelling elderly. 71.8% of men and 77.3% of women reported impairments and among those who reported impairments, 7.5% of men and 10.8% of women reported NPA. NPA is associated not only with age (i.e., the oldest individuals, for women only) and health status (such as a specific type of impairment), but also with socioeconomic (living with intermediate income; living with someone, partner or other) and environmental factors (having and using assistive technologies). © 2008 Elsevier Inc. All rights reserved. 1. Introduction The populations of Western nations are aging, to a greater degree in the European Union than in North America (OECD, 2000). Popu- lation aging is commonly expected to lead to sharp increases in health care expenditures (OECD, 2006), even if this assumption strongly depends on hypotheses made about the impact of aging on health (Zweifel et al., 1999, 2004). It is also assumed that aging will radically change relations between younger and older popula- tions (Henrard, 1996; von Weizsäcker, 1996) by calling into question the need for reforms in health care financing as well as in pension and retirement systems (Lloyd-Sherlock, 2000; von Weizsäcker, 1995; Zweifel, 1990). More importantly, it places into public view the debate about the targeted mix of public subsidies and private provision of care for the elderly (Hoerger et al., 1996; Norton, 2000). The prolonged life span of today may result in an increas- ing number of chronic diseases and ensuing physical or cognitive ∗ Corresponding author at: INSERM 912 – ORS PACA, 23 rue Stanislas Torrents, F-13006 Marseille, France. Tel.: +33 4 91 59 89 02; fax: +33 4 91 59 89 24. E-mail address: alain.paraponaris@inserm.fr (A. Paraponaris). impairments and disabilities. Impairments are defined as any loss or abnormality of psychological, physiological or anatomical struc- ture or function. Disabilities refer to any restriction or lack of ability to perform an activity in the manner or range considered normal for a human being resulting from an impairment (Freedman et al., 2004; WHO, 1980). Although disabilities are a major factor in insti- tutionalization (Branch and Jette, 1982), the majority of disabled elderly individuals continue to live in the community (two thirds of the disabled elderly in France), where they require assistive tech- nology, help from others or both to accomplish the activities of daily living (ADLs). Establishing policies for equitable and appropriate care and assistance for the elderly requires, among other things, an assessment of when and why people with impairments report the need for personal assistance (henceforth referred to as NPA). NPA may be caused by the interaction between physical and/or mental limitations and the environment, which actually hampers people in daily activities as stressed by Pascual and Cantarero for the Euro- pean disabled in a paper published in a recent issue of this journal (Pascual and Cantarero, 2007). A large body of research on the determinants of disabilities (see Stuck et al., 1999, for a survey) has shown that the main factors associated with disability are medical (in particular, cog- 1053-5357/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.socec.2008.10.005