The home medical aid market - France (2023)

1.2 The global homecare market

The home health care market is a sub-segment of the world's fast-growing human services market. Indeed, the latter is estimated at $***.* billion in ****, and is expected to grow at aCAGR of *.*% over the period ****-****, reaching $****.* billion [***]. It is dominated byWestern Europe, followed by Asia Pacific.

Personal assistance market size World, **** - ****, US$ billion Source: ****

The homecare market is also experiencing strong growth worldwide. It is valued at $***.* billion in **** , and should continue to grow at a CAGR of *.**% over the period ****-****, reaching $***.* billion.

This growth is driven in particular by the increasing number of elderly people in the world. Indeed,according to a UN reportreport, the number of people over ** reached *** million in **** , and is expected to more than double to *.* billion by **** .

Size of the global homecare market World, ****-****, in billions of US dollars Source: ****

The homecare market can be segmented into two sectors: equipment and services. By ****, the services market will account for **.*% of the overall market. [***] In terms ofregional segmentation, by ****,North America will have the lion's share, with **.*% of the market. What's more, by ****, * in * Americans will be over **. In Europe,Germany leads the way, closely followed by France. However, it is theAsia-Pacific region ...

1.3 The French homecare market

By ****, sales generated by the personal services sector are estimated at ** billion euros. Homecare accounts for **% of this market, with a value of**.** billion euros. [***]

Sales of medicalized home help, on the other hand, were valued at *.* billion euros in ****, reaching a value of *.* billion euros in ****. Even if the health crisis has slowed growth, sales in this sector have almost doubled (***) in * years, which suggests that it was, for example, sales of homework helpers that fell sharply during the Covid period.

Home medical assistance sales France, ****-****, in billions of euros Source: ****

In an article in Le Figaro, the founder of a homecare group expresses the view that: "In personal services, the seniors business is the most buoyant because of the size of the population concerned (***), the increase in dependency and the fragmentation of the market". The president of the Salon des services à la personne adds: "Demand far outstrips supply. And it's not going to dry up, as the majority of people want to age in their own homes.

However, the business model of homecare service providers (***). These financial challenges are prompting PSADs in particular to cut costs, encouraging closer ties between service providers. [***]

2.1 The aging of the population: a favorable phenomenon for the development of this market

Home medical assistance concerns many types of people who are dependent on others for their care. The benchmark is the group of people who can be helped to live independently.

The aging population: already a reality...

Proportion of the French population aged ** or over France, ****-****, in % Source: ****

...which will continue to driveconsumption of healthcare and medical goods Population projections to **** in millions of inhabitants, France, ****-****, as % of total population Source: CNSA (***) based on INSEE The aging of the French population is real, as this graph shows. While those aged ** and over will represent only *% of the population in ****, their weight in the French population will almost double, reaching **% in ****. [***] This ageing is linked to longer life expectancy and the arrival of the baby-boomers at retirement age: * factors favoring the number of potential consumers for home medical assistance. In addition to the demographic phenomenon, there is a socio-cultural one: the fact that the children of elderly parents are no longer in a position to take care of their parents due to geographical distance, limited economic capacity, etc.

Rising numbers of dependent persons

Number of APA beneficiaries France, ****-****, in billions Source: ****

The rise in the number of dependent elderly ...

2.2 People with disabilities

Disabled people are the second largest group to benefit from home medical assistance .

In ****, *.* million people claimed to provide regular assistance to a loved one with a disability or loss of autonomy. [***]

According to the CNSA, if we approach the number of people with disabilities, we can count people under ** as follows:

*.* million suffer from at least one severe functional limitation (***); *.* million of them also benefited from administrative recognition of disability or loss of autonomy.

2.3 Development of chronic diseases

Visitchronic or long-term illnesses or health problemsdevelop mainly in the oldest age groups, as well as in people with "poor" living conditions.

Thus, on average, in ****, **.*% of non-poor French people in living conditions had chronic or long-lasting illnesses or health problems, compared with **. *% of poor people (***).

What's more, in ****, **.*% of the over-**s had chronic or long-lasting illnesses or health problems, compared with **. *% of the under-**s. Clearly, the aging of the population favors the development of chronic illnesses, which suggests a boom in homecare services.

Share of people declaring a chronic or long-term illness or health problem France, ****, by age and household living conditions Source: ****

According to theWHO, the presence of chronic diseases worldwide is likely to increase by **% over the next decade, accounting for **% of all deaths worldwide. The main chronic diseases are diabetes, cardiovascular disease, chronic respiratory ailments and cancer. These pathologies impair quality of life and require intense, long-term medical treatment.

What's more, according to DREES, polypathologies are becoming more and more frequent, so that by the age of **, **% of women and **% of men have at least three pathologies.

The increase in the number of people suffering from chronic pathologies and polypathologies, combined with the phenomenon of ...

2.4 A growing preference for home help

Harris Interactive carried out a survey in July **** on a sample of *** French people aged ** and over. It is entitled "Collective structures and individual solutions: perceptions and expectations of seniors and parents in the context of the Covid-** crisis". The study shows that home help is becoming increasingly popular with this segment of the population.

First of all, most seniors are increasingly looking forward to living at home. In fact, **% of seniors prefer to age in their own homes, compared with *% in collective structures. Notably, **% of seniors say they have a good image of living at home with the support of personal services professionals. Areas in which homecare is considered most advantageous France, **** Source: ****

In terms of the various choice criteria that are important to seniors, the comparison between home care and structured care is still won by home care:

Price in particular(***), but also personal fulfillment and personalized care.

Only the issue of personal safety gives rise to debate: **% consider home care preferable, compared with **% for group care.

Lack of information and inadequate communication are also hampering the development of home care: the majority declare themselves ill-informed about the conditions under which home care is possible:

Lack of information on ...

2.5 The housing approach supported by public authorities

The demand for home medical assistance is also supported by the public authorities, who want to reduce public spending on dependency care. This is borne out by the Cour des Comptes report to Parliament entitled "Les services de soins à domicile : une offre à développer dans une stratégie territoriorrialisée de gradation des soins".

According to the CNSA's **** edition of Chiffres clés de l'aide à l'autonomie, in ****, public finances would contribute €**.* billion a year to compensate for the loss of autonomy of the elderly (***).

Contribution of public finances to compensating for loss of independence among the elderly and disabled in millions of euros, France, **** Source: ****

Contribution of public finances to compensating for the loss of autonomy of elderly and disabled people

The Social Security item includes :

Disability pensions and long-term care expenses; Urban care expenditure for dependent elderly people at home; Disabled children's education allowance and parental presence allowance.

Various forms of assistance

Various forms of financial assistance are available to help people who are losing their independence to remain at home.

Source: ****

3.1 The forces at work

The market for medical assistance for the frail is mainly shared between public and private not-for-profit players. However, private players are beginning to step up their presence.

Players in the medical-social services sector

Public-sector players are highly localized and include the Centres Communaux d'Action Sociale (***).

Associations are also extremely active in home help and nursing care for dependent people. These private players act in a spirit of social entrepreneurship and solidarity. The main players are :

ADMR, Aide à domicile en milieu rural, which operates in four main areas: autonomy, home comfort services, family and health. The UNA network, France's leading network for home help, care and services.

Finally, private commercial players are still in the minority on the market, but are attempting to strengthen their presence in the home. However, the "Orpéa affair" of March **** has greatly weakened private players specializing in dependency care. [***]

There have also been a number of acquisitions of structures offering homecare services, such as Domidus Vi, which has acquired Domidom Soins.

Homecare service providers

For a long time, the homecare sector was dominated by associations, but today the market is dominated by private companies.

Private structures in France have taken advantage of political and regulatory changes ...

3.2 Competition from nursing homes and other healthcare establishments

EHPADs are in direct competition with the home

The homecare market is in direct competition with retirement homes (***) in France when it comes to the elderly and dependent population.

EHPADs have been affected by the health crisis and the various revelations that have plagued the Orpéa group in particular, pointing the finger at cases of mistreatment that have heightened fears of placement in nursing homes.

However, according to data collected by Finess, in **** there will be ***,*** places for dependent elderly people in *,*** EHPAD, this will be insufficient to meet demand, which is set to rise sharply in the years ahead.

Projected number of Ehpad residents by dependency level in ****, ****, **** France, assuming a constant number of Ehpad places Source: ****

Development of new forms of accommodation for people losing their independence

Independent residences are housing complexes for people over **, combining private apartments and communal areas, and offering access to a wide range of services (***). In **** and ****, the CNAV and CNSA have financed exactly *** projects for the rehabilitation and improvement of independent living residences, to the tune of€** million and €**.* million respectively [***]

In France, new players are emerging, such as medico-social establishments and services for disabled and elderly adults: ESATs (***).

According to the ...

4.1 Types of assistance available at home

Medical and social assistance at home:

Medical assistance at home is a complement or alternative to traditional hospitalization.

It offers people who need it all the services they need to follow their treatment at home, in the comfort of their own home. Of course, this care coordination is organized on the basis of a doctor's prescription.

Medical assistance or hospitalization at home

Hospitalisation at home can provide the following care to shorten or avoid a hospital stay:

Occasional care in the event of an unstabilized illness (***); Rehabilitation care at home in the event of early return from hospitalization (***); Palliative care.

Hospitalisation at home is available for patients of all ages, and can be associated with a SSIAD.

Homecare services

" Home health care providers (***) provide patients suffering from dependency, disability or illness with the medical devices and services required for their medical or paramedical care at home. " [***].

As mentioned above, there are more than *,*** PSAD entities in France, and they will be caring for *.* million people by ****. [***]

Healthcare service providers act as care coordinators for people who are ill or losing their autonomy, by contacting healthcare providers, ensuring the delivery of medical equipment, taking care of patient follow-up and so on.

They ...

4.2 Coverage of various home medical aids

Calculations for private practice nurses :

Source: ****

Coverage of home care by the Assurance Maladie :

Soure : Libheros

HAH prices

Hospitalisation at home is covered by the Assurance maladie:

**%, as for any hospitalization ; ***% in the case of a situation giving entitlement to full coverage (***).

The complementary health insurance may reimburse the difference between the actual costs incurred and the Health Insurance reimbursements.

Medical equipment and teleassistance for homecare :

Source: ****

4.3 New forms of home medical assistance driven by digitalization

Connected help at home thanks to connected objects is booming

According to Odoxa, **% of French people believe that connected objects, the Internet and its applications could help improve "help and maintenance" for the elderly at home. What's more, according toBVA's "Les Français et les objets connectés" (***) survey, connected objects are the most useful for the homecare sector.

Among the fields of application for home help, the French think that these connected objects can improve home security, improve the monitoring of treatments for chronic illnesses (***) and offer tools to help seniors make proper use of medication/adhere to their treatments.

Other trends include applications to break or limit the isolation of seniors (***).

Telemedicine - a digitalization that also affects home medical assistance

Telemedicine is a sub-area of e-health, encompassing innovations in the use of information and communication technologies (***) in healthcare.

In France, telemedicine has been regulated since ****, with the Public Health Code definingdefines * types of medical acts covered by telemedicine [***]:

Teleconsultation: enabling a medical professional to consult a patient remotely; tele-expertise: which enables a medical professional to seek the opinion of other medical experts on the basis of elements in a patient's medical file; remote medical monitoring: enabling a healthcare ...

5.1 Current regulations

Definition of home medical aid services

Decree no. ****-*** of April **, **** relating to the national specifications for home help and support services and amending the Code de l'action sociale et des familles.

Home nursing care services (***) provide care services in the home or in non-medicalized establishments for the elderly and disabled adults and in establishments mentioned in II, III and IV of Article L.***-** of the Code de l'action sociale et des familles .Articles D. ***-* to D ***-*-* of the CASF define the framework for SSIAD action.

The law of December **, ****, relating to the adaptation of society to ageing, proposes in its article ** to experiment, over a *-year period, with changes to the organization, operating and financing arrangements for SPASADs. The aim is to promote the development of this organizational model for home care and assistance, and in particular to improve coordination and encourage the implementation of actions to prevent loss of autonomy.

The Fédération des Prestataires de Santé à Domicile has published a code of good practice for PSADs. This code defines the practices to be implemented by PSADs in the performance of their duties. The three components are the relationship with the patient (***).

Tariffs and ...

5.2 SAAD, SSIAD and SPASAD: setting minimum tariffs for new SADs

Decree no. ****-**** of December **, **** relating to the minimum rate applicable to hours of home assistance and to the allocation to guarantee the integrated operation of assistance and care within a home autonomy service (***).

Theorder of December **, **** relating to the minimum tariff mentioned in I of article L. ***-*-* of the CASF and setting its amount for **** on the other hand.

6.1 Market segmentation

• AD Seniors
• ADHAP Services
• Senior Compagnie (Groupe Zephyr)
• Aquarelle Service
• Age d’Or Services
• Petit-Fils (Korian Groupe)
• Solutia Groupe
• Oui Care
• Domidom
• Adomis (Zephyr groupe)
• Adenior
• ADMR
• UNA
• DomusVi
• Orkyn (Air liquide)
• Homeperf
• Korian Clariane
• Bestens umsorgt (KORIAN Group)
• Zephyr Groupe
• Elivie (Groupe Santé Cie)
• Asten Santé (La Poste)
• La Poste
• Air Liquide Santé
• Dinno Santé