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Historically, French medico-social establishments and services (ESMS) have operated under a retrospective financing system known as “charges-based,” which derives from their authorization scheme: the public authority issuing the authorization had to cover operating expenses and the amortization of investments if it wanted the service to be provided properly. The rise in dependency among older adults and the growing awareness of shortcomings in support for persons with disabilities in France between 2003 (the year of the heatwave) and the passing of the February 11, 2005 law led to changes in this long-standing framework. The identification of a risk linked to loss of autonomy, marked by the creation of the allocation personnalisée d’autonomie (personalized autonomy allowance) in 2001 and the Caisse nationale de solidarité pour l’autonomie (National Solidarity Fund for Autonomy) in 2004, followed by successive plans for older adults and persons with disabilities, have led to far-reaching changes in the financial governance of the sector. Reforms to make pricing fairer, both in terms of equity between ESMS and in relation to the needs of the public, have not resolved all the difficulties of ensuring sufficient numbers of staff to deliver quality support. The constrained management of medico-social sub-targets within the National Health Insurance Expenditure Target (ONDAM) is one of several explanatory factors. In the absence of references concerning the right level of resources, it is difficult to go beyond the general observation of inadequate resources for people with the greatest loss of autonomy, and to develop reforms that are fully relevant.