ALL WORKING PAPERS
2010 - 2009 - 2008 - 2007

WORKING PAPERS 2010

Not having been submitted to the usual IRDES review procedures, these working papers express the views of the authors and do not necessarely reflect the views of IRDES.

Effort or Circumstances: Does the Correlation Matter for Inequality of Opportunity in Health?
Jusot F. (University Paris-Dauphine, LEDA-LEGOS, IRDES), Tubeuf S. (University of Leeds, Academic Unit of Health Economics), Trannoy A. (EHESS, GREQAM-IDEP)
IRDES working Paper n° 33. 2010/07.

This paper proposes a method to quantify the contribution of inequalities of opportunities and inequalities due to differences in effort to be in good health to overall health inequality. It examines three alternative specifications of legitimate and illegitimate inequalities drawing on Roemer, Barry and Swift’s considerations of circumstances and effort. The issue at stake is how to treat the correlation between circumstances and effort. Using a representative French health survey undertaken in 2006 and partly designed for this purpose, and the natural decomposition of the variance, the contribution of circumstances to inequalities in self-assessed health only differs of a few percentage points according to the approach. The same applies for the contribution of effort which represents at most 8%, while circumstances can account for up to 46%. The remaining part is due to the impact of age and sex.

OOP Safety Net Threshold: A Choice between Equality and Equity? An Analysis using the ARAMMIS model
Debrand T., Sorasith C. (IRDES).
IRDES working paper n° 32. 2010/06

Using the microsimulation model ARAMMIS, this study attempts to measure the impacts of introducing an out-of-pocket (OOP) maximum threshold or a safety net threshold on consumer copayments for ambulatory care financed by the abolition of the Long-term Illness Regime (ALD) in France. The analysis is based on a comparison of different safety net threshold rules and their redistributive effect on patients’ OOP. We attach particular importance to indicators that bring to light changes in OOP payment levels and measure their impact on the equity of OOP distribution. The first section outlines the French National Health System to provide a better understanding of the stakes involved in reforming the healthcare reimbursement rules under the Compulsory Health Care Insurance scheme. In the second section, we describe the hypotheses retained, the data base and the microsimulation model. The final section presents key findings measuring the impact of the reform at both individual and system levels.

Determinants of the Price Difference between Reference and Follow-on Drugs
Bergua L. in collaboration with Sermet C., Sorasith C. and Célant N. (IRDES).
IRDES working paper n° 31. 2010/04. In revision

Monitoring Health Inequalities in France: A Short Tool for Routine Health Survey to Account for LifeLong Adverse Experiences
Cambois E. (Ined), Jusot F. (Université Paris-Dauphine, Leda-Legos, Ined, IRDES).
IRDES working Paper n° 30. 2010/03.

Conventional health surveys focus on current health and social context but rarely address past experiences of hardship or exclusion. However, recent research shows how such experiences contribute to health status and social inequalities. In order to analyse in routine statistics the impact of lifelong adverse experiences (LAE) on various health indicators, a new set of questions on financial difficulties, housing difficulties due to financial hardship and isolation was introduced in the 2004 French National health, health care and insurance survey (ESPS 2004).
Logistic regressions were used to analyze associations between LAE, current socioeconomic status (SES) (education, occupation, income) and health (self-perceived health, activity limitation, chronic morbidity), on a sample of 4308 men and women aged 35 years and older.
In our population, LAE were reported by 1 person out of 5. Although more frequent in low SES groups, they concerned above 10% of the highest incomes. For both sexes, LAE are significantly linked to poor self-perceived health, diseases and activity limitations, even controlling for SES (OR>2) and even in the highest income group. This pattern remains significant for LAE experienced only during childhood.
The questions successfully identified in a conventional survey people exposed to health problems in relation to past experiences. LAE contribute to the social health gradient and explain variability within social groups. These questions will be useful to monitor health inequalities, for instance by further analyzing LAE related health determinants such as risk factors, exposition and care use.

Effect of a French Experiment of Team Work between General Practitioners and Nurses on Efficacy and Cost of Type 2 Diabetes Patients Care
Mousquès J.*, Bourgueil Y.*, Le Fur P.*, Yilmaz E.**
IRDES working Paper n° 29. 2010/01.

This study aims to assess the efficacy and the cost of a French team work experiment between nurses and GPs for the managing of type 2 diabetes patients. Our study was based on a case control study design in which we compare the evolution of process (standard follow-up procedures) and final outcomes (glycemic control), and the evolution of cost. The study is realized for two consecutive periods between type 2 diabetes patients followed within the team work experiment (intervention group) or by “standard” GPs (controlled group).

After 11 months of follow-up, we showed that patients in the intervention group, compared with those in the controlled group, have more chances to remain or to become: correctly followed-up (with OR comprise between 2.1 to 6.8, p<=5%) and under glycemic control (with OR comprise between 1.8 to 2.7, p<=5%). The latter result is obtained only when a visit for education and counselling has been delivered by a nurse in supplement to systematic electronic patient registry and electronic clinical GPs reminder. All these results are obtained without difference in costs between the intervention and the controlled groups.

Finally, this experimentation of team working can be considered both effective and efficient. Our findings may have implications in the design of future larger primary care team work experiments to be launched by French health authorities.

* IRDES, Prospère
** Drees (Health Ministry)