QUESTIONS D'ÉCONOMIE DE LA SANTÉ 2015
Issues in Health Economics
Issues in Health Economics (in French : Questions d'économie de la santé) is a monthly publication presenting syntheses of latest Irdes research on health economics. Benefiting from a high public visibility, this publication is systematically translated in English.
Measuring Polypharmacy in the Elderly: Impact of the Method on Prevalence and Therapeutic Classes
Issues in Health Economics (Questions d'économie de la santé) n° 213. 2015/10.
Le Cossec C. (Irdes) and Sermet C. (Irdes), in collaboration with Perronnin M. (Irdes)
Increased life expectancy is accompanied by an increase in years of living with one, or even several, chronic diseases causing an accumulation of drug therapies, thus increasing the iatrogenic risks. In recent years, public policies to reduce polypharmacy in the elderly have been established. Their assessment requires easy-to-produce indicators from large population databases. Two indicators are considered here: the "cumulative" polypharmacy indicator, which takes into account all drugs administered over a given period, and the "continuous" polypharmacy indicator, which focuses on drugs taken regularly over a prolonged period of time. The innovative aspect of this work is the consideration of combination drugs and quarterly packs in the calculations. The polypharmacy prevalence varies from 27% to 40% depending on the indicator, with or without consideration of the combination drugs and large packs.
The Consequences of a Traumatic Tetraplegia on Forming a Union
Issues in Health Economics (Questions d'économie de la santé) n° 212. 2015/09.
Espagnacq M. (Irdes), Ravaud J.-F. (Inserm, IFRH)
Understanding the links that can exist between a severe disability, such as tetraplegia, and marital status is especially difficult as the data on the subject is rare. The Tétrafigap surveys, conducted in 1995 and 2006, permit to study the medium and long term evolution of union-formation, by monitoring the same population of spinal cord injured tetraplegics over more than ten years. The aim is, first, to measure the impact of severe disabilities on couple formation and, second, to define the elements that influence the possibility of a union.
These injuries, often due to public highways or sports accidents, mainly concern a young male population, about 80% of men in their twenties at the time of the accident. In Tétrafigap cohort, over 60% of respondents were single at the time of the accident and 50% of them forming a union since. Starting a union after such trauma is no marginal phenomenon. The analysis of factors influencing the union formation has shown that socio-environmental elements have a much stronger influence on the probability of forming a union than elements referring to autonomy or to the clinical situation.
The Impact of Multiprofessional Group Practices on the Quality of General Practice
Results of the Evaluation of Multidisciplinary Group Practices (MGP), Health Care Networks (HCN) and Health Care Centers (HCC) Participating in Experiments with New Modes of Remuneration (ENMR)
Issues in Health Economics (Questions d'économie de la santé) n° 211. 2015/07-08.
Mousquès J. (Irdes), in collaboration with Daniel F. (Irdes)
What are the impacts of multiprofessional group practice in the three types of health care facility - multidisciplinary group practices (MGP), health care networks (HCN) and health care centers (HCC) - having participated in the Experiments with New Modes of Remuneration (ENMR)? Have the quality of general practice and the efficiency of prescribing improved in ENMR sites compared with solo practices? Do notable differences between MGP, HCN and HCC emerge? Do the analyses show that ENMR has had an impact?
These questions are examined in the sixth publication in a series on the evaluation of multiprofessional group practices having participated in ENMR. The quality and efficiency of general practice in ENMR sites was compared with that of control sites over a period of four years from 2009 to 2012. The analyses concerned four main dimensions of general practice: the monitoring of type 2 diabetes patients, vaccination, screening and prevention, and the efficiency of prescribing.
Multiprofessional Group Practices Generate Gains in Terms of Productivity and
Expenditures Results of the Evaluation of Multidisciplinary Group Practices (MGP), Health Care Networks (HCN) and Health Care Centers (HCC) Participating in Experiments with New Modes of Remuneration (ENMR)
Issues in Health Economics (Questions d'économie de la santé) n° 210. 2015/06.
Mousquès J. (Irdes), in collaboration with Daniel F. (Irdes)
What are the impacts of multiprofessional group practice in the three types of health care facility - multidisciplinary group practices (MGP), health care networks (HCN) and health care centers (HCC) - having participated in the Experiments with New Modes of Remuneration (ENMR) between 2010 and 2014? Are general practitioners working in ENMR sites more active and productive than the others? Do they have similar practice structures? Do their patients use the different categories of ambulatory care more or less frequently? Are their medical expenditures lower or higher? Are the results homogeneous or heterogeneous between the different types of sites participating in ENMR?
These questions are adressed in this fifth publication in a series evaluating multiprofessional group practices in health centers having participated in ENMR. The quantitative evaluation analyses measuring the impact of multiprofessional group practice on health care activities and services are based on a quasi experimental design.
How Will Employer-Mandated Complementary Health Insurance Impact Insurance Coverage in France?
A simulation based on the 2012 Health, Health Care and Insurance survey (ESPS)
Issues in Health Economics (Questions d'économie de la santé) n° 209. 2015/05.
Jusot F. (Université Paris-Dauphine-Leda-Legos, Irdes), Pierre A. (Irdes)
In France, access to health care is highly dependent on whether or not individuals possess complementary health insurance (CHI), which in 2012 was not the case for 5% of the population. Access to a quality complementary health insurance policy for all thus became a core factor in the national health strategy set out by the government in 2013. The first measure, negotiated within the framework of the National Interprofessional Agreement (NIA) of January 2013, will compulsorily mandate employer to provide sponsored contracts to all private sector employees on January 1st 2016, and improve coverage portability of this coverage to unemployed former employees for up to 12 months following termination of their work contract.
This article aims to provide an ex ante evaluation of the expected impact of NIA on coverage rates in France and to discuss its implications in terms of health inequalities. Based on the 2012 Health, Health care and Insurance survey (ESPS), we simulate the proportion of individuals that would remain uninsuranced after NIA in the general population and within the private employees, taking into account the waiver clause exempting some of them to subscribe to the employer-sponsored CHI. Non-coverage is studied according to individual characteristics such as health status, socio-economic status and time and risk preferences.
People with Disabilities Living at Home Have Lower Access to Preventive Care than People without Disabilities
Exploitation of the Health and Disability Survey, Household Section (2008)
Issues in Health Economics (Questions d'économie de la santé) n° 208. 2015/04.
Penneau A., Pichetti S., Sermet C. (Irdes)
Due to an increase in life expectancy, people with disabilities are now confronted with the same age-related diseases as the rest of the population. Access to preventive care and screening procedures should thus make it possible to avoid the premature deterioration of disabled persons' heastatus. Yet, the literature shows that this population is confronted with numerous barriers to accessing both preventive and routine care: difficulties expressing their care needs, more disadvantaged socio-economic situations leading to a lower use of health care services, physical difficulties in accessing doctors' surgeries and unadapted consultation equipment, together with care providers' lack of awareness regarding disability...
This study on the use of health care and prevention among people with disabilities living at home examines four screening or prevention procedures based on data provided by the Health and Disability Household survey (HSM), conducted by the DREES and INSEE in 2008: screening against cervical, breast and colon cancers and vaccination against hepatitis B. The aim of the study is to evaluate differences in the use of these preventive care procedures according to disabled persons' situations. Two indicators were retained for the analysis, functional limitations (motor, cognitive, visual or hearing limitations) and administrative recognition of disability.
Institutionalisation Favours Access to Health Care for Disabled Persons Aged under 60 in France
Exploitation of the Health and Disability Households and Institutions survey (2008-2009)
Issues in Health Economics (Questions d'économie de la santé) n° 207. 2015/03.
Penneau A., Pichetti S., Sermet C. (Irdes)
To date, disabled persons' access to health care has essentially been studied in relation to people without a disability. The literature shows that physical difficulties in accessing care, together with the more disadvantaged socioeconomic conditions to which disabled persons are subject, are among the main explanatory factors regarding their lower use of health care services. Moreover, if disabled persons' access to health care is well documented for those living at home, it is less well documented for those living in institutions. The rare studies comparing access to health care between these two populations have been focused on dental care and have shown that life in an institution appears to increase the probability of having access to the care in question. Does this result concerning dental care also apply to other types of health care?
The Health and Disability Households (HSM, 2008) and Institutions (HSI, 2009) survey, conducted by the DREES and INSEE made it possible to compare the use of health care services between people with disabilities living at home and those living in institutions for three types of routine care (dental, ophthalmological and gynaecological care) and four types of preventive care (screening against breast cancer, colorectal cancer, cervical cancer and vaccination against hepatitis B). In order to compare these two populations, the retained definition of disability was based on activity limitations in the domain of personal care (Activities of Daily Living, ADL) or domestic life (Instrumental Activities of Daily Living, IADL) reported by survey respondents.
Variable Care Modalities for Schizophrenic Disorders in Health Care Facilities in 2011
Issues in Health Economics (Questions d'économie de la santé) n° 206. 2015/02.
Coldefy M., Nestrigue C. (Irdes)
Schizophrenia, a severe and debilitating mental disorder, affects around 1 to 2% of the adult population in France; approximately 400,000 people (Haute autorité de santé , HAS, 2007). By nature, not only is it one of the severest psychiatric disorders in terms of suffering for those affected and their families, but also one of the most costly for society: early-onset, often developing into a chronic disorder leading to frequent hospitalisations, the intensity of treatments, and a high level of disability leading to difficulties maintaining a job.
Based on data supplied by the Medical Information System for Psychiatry (Rim-P), the aim of this study is to extend knowledge on the treatment of this disorder in French health care facilities. After presenting the characteristics of patients monitored and treated in these facilities, differences in the modalities of care provided are observed according to type of health care facility. These are as varied as the different phases of this complex disorder requiring a wide range of care modalities: from full-time hospitalisation to a range of part-time and out-patient care.
From Compulsory Psychiatric Hospitalisation to Compulsory Treatment: First Results Following the Institution of the Law of July 5th 2011
Issues in Health Economics (Questions d'économie de la santé) n° 205. 2015/01.
Coldefy M., Tartour T., In collaboration with Nestrigue C. (Irdes)
Based on data provided by the Medical Information Database for Psychiatry (Rim-P, Recueil d'informations médicalisées en psychiatrie), this study on compulsory psychiatric treatment following the enactment of the Law of July 5th 2011 follows a first overview for the year 2010 conducted prior to its enactment (Coldefy, Nestrigue, 2013). The law, modified in September 2013, aims at providing for alternatives to full-time compulsory psychiatric hospitalisation by introducing a new legal procedure applicable in cases of imminent danger, acute involuntary admission, (SPI, soins en cas de péril imminent), and the intervention of a liberty and custody judge (juge des libertés et de la détention (JLD)) instituted within the legal framework.
This study presents the first results in the year following the enactment of the law and its deployment in France, and explores its impact on patient care. It is essentially focused on two sections of the law: the introduction of individual care plans and SPI. The aim of the study is to describe changes in involuntary psychiatric care following the implementation of the law, and to measure psychiatric activity by answering several questions: how can changes in the use of involuntary psychiatric care be characterised? To what extent do health establishments use the new legal procedures? What are the contents of an individual care plan? Which patients benefit from it? Has this reform improved access to continuity of care for patients with psychiatric disorders that can temporarily alter their awareness of the disorder or the need for psychiatric treatment?