ABOUT IRDES

PUBLICATIONS

INTERNATIONAL

SURVEYS

CONFERENCES & WORKSHOPS

OUR SERVICES...

WORKING PAPERS 2012

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.









WP n° 53

Care Quality and Activity-Based Funding: for Better or Worst?
Or Z. (Irdes), Häkkinen U. (THL)
Irdes working paper n° 53. 2012/12

Activity-based funding which links hospital finances to their production, as measured by Diagnostic Related Groups (DRGs), is being used increasingly in many countries to improve efficiency of hospital activity. It has been argued that improvements in measurement and management of hospital production through DRGs should lead in turn to better quality of care. However, there are many different ways that activity-based funding may create perverse incentives which could have a negative impact on care quality. This article explores the possible impacts of DRG-based funding in terms of treatment policy and medical outcomes and discusses how these payment models could be adjusted to improve care quality.

The basic DRG-payment model does not provide direct incentives to hospitals to im- prove the quality of care provided. However, it can be modified to: give explicit incentives for higher-quality treatments; penalise “bad quality care”; or improve care process and patient outcomes by granting funds for progress made. Therefore DRG-based payment may represent risks but also provides opportunities for improving care quality in hospitals. This requires continuous refinement of data and the monitoring of care quality as well as treatment costs. However, in many countries, information on patient outcomes and process quality is still not routinely collected.

WP n° 52
WP n° 52bis

On the Socio-Economic Determinants of Frailty: Findings from Panel and Retrospective Data from SHARE
Sirven N. (Irdes)
Irdes working paper n° 52. 2012/12 & Irdes working paper n° 52bis. 2013/04

Recent studies on the demand for long-term care emphasised the role of frailty as a specific precursor of disability besides chronic diseases. Frailty is defined as vulnerable health status resulting from the reduction of individuals’ reserve capacity. This medical concept is brought here in an economic framework in order to investigate the role social policies may play in preventing disability or maintaining life quality of people in a disablement process.

Using four waves of panel data from the Survey on Health, Ageing, and Retirement in Europe (SHARE), a frailty index is created as a count measure for five physiologic criteria (Fried model) for respondents aged 50+ in 10 European countries, between 2004 and 2011.

The longitudinal dimension is explored in two ways. First, differences in frailty dynamics over a seven-year-time period are analysed through variables that are relevant for social policy (income maintenance, housing adaptation, and prevention of social isolation) in a panel model for count data with fixed effects. Second, the individual fixed effects are decomposed by means of a random effects model with Mundlak specification. SHARE additional retrospective data on life history (SHARELIFE) are then used to investigate differences in frailty levels.

The results reveal the presence of various sources of social inequalities over the life-course. Social Protection Systems thus appear to play a major role in accompanying, preventing or reducing the frailty process. Several policy implications are suggested.

WP n° 51

Local Potential Accessibility : A New Measure of Accessibility to Private General Practitioners in France
Barlet M. (Drees), Coldefy M. (Irdes), Collin C. (Drees), Lucas-Gabrielli V. (Irdes)
Irdes working paper n° 51. 2012/12

Within the health system, primary care plays an essential role in maintaining population health. Despite a present favorable situation of the French care supply, the increasing role of general practitioners, spatial disparities, decreasing demographic trends in the short run, and great expectations of old people whose care need is high and mobility reduced, make accessibility to health care become a major issue on the political agenda.

In this research, we put into question the measure of spatial accessibility to general practitioner. Using recent advancements in health geography of primary care, we propose to apply the ‘Two-step floating catchment area’ method to the French context of care. This indicator allows us to consider health supply and demand as well as geographic accessibility simultaneously. But basic computation of this indicator presents some limitations we attempt to deal with. We propose to improve the measure of accessibility to primary care in three directions: definition and quantification of the supply, integration of health care needs on the demand side and a more accurate definition of interaction between both. Finally, this measure of local potential accessibility renews classical approaches of accessibility to primary care in France and deals with local problems of healthcare resources to needy population.






WP n° 50

Sick Leaves: Understanding Disparities Between French Departments
Ben Halima M. A., Debrand T., Regaert C. (Irdes)
Irdes working paper n° 50. 2012/10

The purpose of this publication is to better understand disparities between the proportions of sick leaves granted among various departments in France. The Hygie database was used for this study. It was created by merging a number of administrative fi les of employees in the private sector in France in 2005. This database allows for the determination of «employer/employee» relations, the impact of the characteristics of firms on the health of their employees and the interactions between health and work.

After briefly reviewing the various determinants for the effect of composition and the effect of context, as well as sick leaves and their importance for understanding geographic differences, we present a three-phase empirical analysis: a descriptive analysis to detect differences between departments, a multivariate analysis to highlight explanatory factors of probability of being on sick leave and, finally, an analysis of determinants of differences between departments.

Our different models explain a signifi cant portion of the disparities between departments. The effects of composition and effects of context account for approximately two-thirds of the mean squared error. The variables describing the medical supply (density of general practitioners), monitoring by National Health Insurance and patient age when the professional career began best explain the disparities between departments concerning sick leave. In contrast to other compositions or contexts included in our model, the percentage of sick leaves verified and the density of general practitioners are important factors with respect to health policies. Our research shows that they could be used as public policy instruments aimed at reducing geographic disparities.

Which gave rise to: Issues in Health Economics (Questions d'économie de la santé) n° 177, 2012/06.
Sick Leave: What Explanation for Disparities between French Departments? First exploitation of the Hygie database.
Ben Halima M. A., Debrand T., Regaert C.

Published in: Revue française d’économie, vol 26, n°4, 2012/04.

 

WP n° 49

Entry Time Effects and Follow-on Drugs Competition
Andrade L.F. (Gate-Groupe d’analyse théorique et économique, Lyon ; Irdes)
Irdes working paper n° 49. 2012/06

Pharmaceutical firms have been criticized for concentrating their efforts of R&D on the so called “me-too” or “follow-on” drugs. There have been many comments against and favourable to the dissemination of these incremental innovations but few papers have broached the subject from an empirical point of view, possibly because identification of “me-too” is not so obvious. This paper focuses on the impact of entry order on “follow-on” drugs competition in the French market between years 2001 and 2007. More precisely, this study examines the effects on market share of first entrants in the follow-on drug market and how this possible competitive advantage changes over time. Our results are coherent with theoretical microeconomic issues concerning the importance of being first. We find evidence that first movers in the follow on drug market have the ability to capture and maintain greater market share for a long period of time. The hierarchical market position of follow on drugs does not seem to be affected by generic drugs emergence. From a dynamic perspective, our analysis shows that market share is positively correlated with the ability of follow on drugs to set prices higher than the average follow-on drug price in a specific therapeutic class (ATC) which means that market power remains considerably important for first movers. Finally we found that the optimum level of innovation to maximize market share is the highest one.


WP n° 48

Active Ageing Beyond the Labour Market: Evidence on Work Environment Motivations
Pollak C. (Irdes, Paris School of Economics, Centre d’économie de la Sorbonne - Université Paris 1), Sirven N. (Irdes)
Irdes working paper n° 48. 2012/05

This paper is integrated into the research project HEAPS, which concerns the health and the participation of the Olders in society. "Active Ageing” strategies aim to foster the participation of seniors in the society. Although economic literature has extensively studied the incentives for seniors to increase their labour supply, little is known about the motivations for older people to complement labour with other forms of social participation. Using data from the Survey of Health, Ageing and Retirement in Europe, this article provides empirical evidence of the motivational role of the work environment in the supply of formal and informal productive activities of 50 to 65 year old workers. The results show that intrinsic rewards received at work, such as skill development opportunities and decision latitude, form an incentive for older workers to invest time in social activities outside the labour market. Extrinsic rewards on the other hand, like advancement perspectives, job security and pay, appear independent from non-market outcomes. Therefore, the opportunity for work time arrangements but also intrinsic rewards in the work environment should be developed if one aims to foster participation of older workers in the society.



WP n° 47

Paying for health services can be dangerous for your health. A Study of Self-Assessed Unmet Needs (SUN) for financial reasons
Dourgnon P., Jusot F., Fantin R. (Irdes)
Irdes working paper n° 47. 2012/04

In this paper, we analyse self-assessed unmet needs (SUN) for financial reasons and then study their consequences on health status four years later using ESPS data, a French general population survey on health, health care and insurance. Financial hurdles in accessing care as assessed by SUN are principally explained by lack of complementary health insurance coverage and life course episodes, in particular past and present socio-economic conditions and perspectives. The analysis also shows that difficulties in accessing care contribute to health inequalities.









WP n° 46

Cross-Country Performance in Social Integration of Older Migrants. A European Perspective
Berchet C. (LEDa-LEGOS-Université Paris-Dauphine, Irdes), Sirven N. (Irdes)
Irdes working paper n° 46. 2012/03

This paper provides new empirical evidence on the relationship between migration and social integration. It explores the hypothesis that migrants essentially differ from non-migrants with regard to the length of residence in the country – which is a proxy of migrants’ social distance to natives. The determinants of social participation and interpersonal trust are examined at both the individual and institutional level. Using SHARE data and macroeconomic series, we first analyse the influence of immigrant length of stay in the host country on social integration indicators. We then examine the role institutional characteristics play on cross-country differences in speed of social integration (i.e. immigrants’ propensity to social participation according to their length of stay in the host country). As expected, the immigrant population presents a lower likelihood than the native population to get involved in social activities and to trust other people. Nevertheless, the more immigrants have spent time in the host country, the more they take part in social activities. The analysis also reveals significant cross-country differences in immigrants’ speed of social integration. Macroeconomic series like the GINI coefficient of income inequality and the Corruption perceived index could explain these differences. From a public policy perspective, our results suggest that immigrants’ social integration is more rapidly achieved in “fair” countries – i.e. those with a more favourable social environment – where the levels of income inequality and perceived corruption are lower.

WP n° 45

Employed and Happy despite Weak Health?
Labour Market Participation and Job Quality of Older Workers with Disabilities

Pollak C. (Irdes)
Irdes working paper n° 45. 2012/03

European countries with high senior employment rates have the highest levels of job satisfaction despite an older and more physically limited workforce. In this paper, we argue that this paradox can be explained by heterogeneous levels of job quality: better working conditions may enable older workers with disabilities to remain satisfied and employed. Using panel data from the Survey of Health, Ageing and Retirement in Europe, we find that health status, job satisfaction, but also working conditions, are major individual determinants of early labour market exits. We also show that high intrinsic and extrinsic rewards can mitigate the selective effects of disability. Finally, the comparative analysis reveals that older workers with disabilities are more likely to be employed in countries where they receive higher rewards. The findings therefore indicate that improved job quality is a major factor of successful active ageing strategies.





WP n° 44

Cost of Hospital Adverse Events in France
Nestrigue C., Or Z. (Irdes)
Irdes working paper n° 44. 2012/02

European countries with high senior employment rates have the highest levels of job satisfaction despite an older and more physically limited workforce. In this paper, we argue that this paradox can be explained by heterogeneous levels of job quality: better working conditions may enable older workers with disabilities to remain satisfied and employed. Using panel data from the Survey of Health, Ageing and Retirement in Europe, we find that health status, job satisfaction, but also working conditions, are major individual determinants of early labour market exits. We also show that high intrinsic and extrinsic rewards can mitigate the selective effects of disability. Finally, the comparative analysis reveals that older workers with disabilities are more likely to be employed in countries where they receive higher rewards. The findings therefore indicate that improved job quality is a major factor of successful active ageing strategies.

Which gave rise to: Issues in Health Economics (Questions d'économie de la santé) n° 171, 2011/12.
Excess Costs of Adverse Events in Hospitals in France First estimations using nine patient safety indicators.
Nestrigue C., Or Z.

WP n° 43

Explaining Price Discrepancies between Me-Too Drugs and the First-In-Class
Sorasith C. (Irdes), Pichetti S. (Irdes), Cartier T. (Université Paris Diderot, Sorbonne Paris Cité, Irdes), Célant N. (Irdes), Bergua L. (CHU de Rouen), Sermet C. (Irdes)
Irdes working paper n°43. 2012/02

The development of so-called me-too drugs leads to controversial debates dealing with their substitutability, the opportunity of their presence on the market and their price. In this paper, we first bring together me-too drugs in 31 homogeneous groups of drugs considering that drugs in each group have to show the same principal molecular structural features and the same therapeutic indications. We then calculate in each group the price discrepancies between the first-in-class and each me-too drug in the class and we analyze explaining factors of these gaps. We consider the life cycle of each drug as a whole over the period between 2001 and 2009, considering both the date of the arrival on the market and later events such as price changes. We use a multi-level model which takes into account the temporal structure of the data and the fact that me-too drugs belong to a group.

Results show that in a group, me-too drugs are on average 59% more costly than firstin-class. In a given group, more innovation is associated with higher price gaps. On the contrary, arrival of generic drugs on the market or the fact that drugs are included in reference price groups (so-called “Tarif Forfaitaire de Responsabilité” [TFR] in France) tend to reduce the price gaps between me-too drugs and first-in-class. For those drugs that are available in several dosages, monotonic pricing, i.e. a price which is proportional to dosage, leads to higher price discrepancies and can be considered as unfair for patients who have to buy higher dosages. Finally, price gaps increase with drugs market shares, which contrasts with the price rule announced by the regulator.

This document supersedes:

Determinants of the Price Difference between Reference and Follow-on Drugs
Bergua L., en collaboration avec Sermet C., Sorasith C., Célant N.
Irdes working paper n° 31. 2010/04.

Our newsletter
Subscribe
Contact
Legal information
Sitemap
Useful links
Access
News
Latest publications
RSS


September 17th, 2013