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.

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An Evaluation of the Health Ageing and Retirement Project (PARI): Phase 1
Is it possible to Use Administrative Data to Identify Risks for Vulnerable Elders?

Issues in Health Economics (Questions d'économie de la santé) n° 224. 2017/03.
Sirven N. (LIRAES (EA 4470), Université Paris Descartes, and IRDES)

The Health Ageing and Retirement Project (Programme d'Action pour une Retraite Indépendante), known as the Pari project, implemented by the French Social Security Fund for Self-Employed Workers (Régime Social des Indépendants, or RSI), is aimed at RSI contributors aged between 60 and 79. Using the RSI's medico-administrative documents, the plan aims to produce a diagnostic analysis of individual situations in order to detect economic, social, and health-related frailty and anticipate loss of autonomy, by providing coordinated solutions that are adapted to specific cases.
The Pari project's efficacy is primarily based on its ability to detect individual needs. This preliminary study aims to assess the effectiveness of the Pari plan's capacity to detect individual needs. Its objective is to assess to what extent ‘target individuals' - whose loss of autonomy could be anticipated thanks to a suitable service offering - are correctly identified using the Pari project's diagnostic tool. The preliminary results of the evaluation demonstrate that the project's detection system detected persons who had needs - particularly social ones - that were hitherto undetected. This evaluation study will need to be complemented by controlled experimentation aimed at analysing and ascertaining the effectiveness of the supportive initiatives implemented by the Pari plan.

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The State of Public Health in France and Risk Factors
Preliminary Results of the 2014 European Health Interview Survey - The Health, Health Care and Insurance Survey (EHIS-ESPS 2014)

Issues in Health Economics (Questions d'économie de la santé) n° 223. 2017/03.
Pisarik J. (DREES), Rochereau T. (IRDES), In collaboration with Célant N. (IRDES)

According to the preliminary results of the 2014 European Health Interview Survey: The Health, Health Care and Insurance Survey (EHIS-ESPS 2014), conducted in private households (non-institutional population), almost one third of the population (aged 15 or over) in mainland France rated their health as fair, poor, or very poor. Almost 40% of respondents stated they had a chronic medical condition and a quarter had a health condition that limited their ability to perform common daily activities. These health indicators varied greatly according to the socio-professional categories, to the detriment of disadvantaged sections of the population, particularly households of unskilled workers. Almost one in ten women and one in twenty men had depressive symptoms, which were more acute in persons aged 75 or over, and mainly concerned employed households. With 7% of the population suffering from depression, France is on a par with the European average.
Among the risk factors, 46% of the population in mainland France was excess overweight, (31% overweight, and 15% obese), which is less than most of the other European countries that took part in the survey. However, 28% of the respondents smoked (22% smoked daily), representing a smoking rate that is higher than the European average. These two risk factors vary greatly according to the socio-professional categories, to the detriment, in particular, of working-class households. Two other Issues in Health Economics/Studies and Results (Questions d'économie de la santé/ Études et Résultats) will be published in 2017, presenting the preliminary results relating to health insurance and access to healthcare. All the survey's results will, in any case, be released in an IRDES (Institute for Research and Information in Health Economics) report, which will be published in 2017.

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Compulsory Psychiatric Treatment: An Assessment of the Situation Four Years after the Implementation of the Act of 5 July 2011
Issues in Health Economics (Questions d'économie de la santé) n° 222. 2017/02.
Coldefy M. (Irdes), Fernandes S. (ORU-Paca, Université Aix-Marseille), In collaboration with Lapalus D. (ARS Paca)

French law relating to compulsory psychiatric treatment was amended by the Act of 5 July 2011. It reaffirmed the rights of people receiving compulsory treatment and introduced two key measures: the intervention of the judge of freedom and detention ("juge des libertés et de la détention" or JLD), who monitors the need for compulsory treatment, and the possibility of compulsory ambulatory care as part of treatment programmes. In addition, a new form of admission "in the case of imminent danger" (Acute Involuntary Admission or AIA) was introduced to facilitate access to care for isolated and socially excluded people.
Based on medico-administrative data, this study analyses the evolution in the use of compulsory psychiatric treatment since the introduction of the Act in 2011. 92,000 people received compulsory treatment in 2015, that is 12,000 more people than in 2012. This rise is explained by several factors: the extension of the duration of out-of-hospital compulsory care, as part of treatment programmes, and the rise in the treatment rates for people in imminent danger. Used to facilitate hospital admission in emergency situations and relieve third parties of this difficult process, this mechanism is used in a disparate manner, depending on the geographical area in France.

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June 20th, 2017