Chenu A., Lesnard L.
Paris : SciencesPo Les Presses : 2011 : 221 p.
Les avancées récentes des sciences sociales doivent beaucoup aux grands programmes et enquêtes statistiques qui permettent de comparer dans différents pays aussi bien l'impact des choix effectués en matière de politiques publiques que les évolutions des sociétés. Ces données sont maintenant facilement accessibles grâce à des centres d'archivage spécialisés qui les mettent gratuitement à la disposition des étudiants et des chercheurs. Mais jusqu'ici sociologues et politistes français étaient, dans l'ensemble, peu familiers de ces enquêtes et des réseaux d'archives. Cet ouvrage se veut un manuel d'initiation aux enquêtes comparatives et au partage des données internationales. Dans cet objectif de pédagogie, et dans une approche exempte de jargon statistique, les auteurs dressent ici un bilan des acquis essentiels de ces enquêtes dans les domaines des comportements électoraux, de la religion et des valeurs, des modes de vie, des pratiques culturelles, de la mobilité sociale, des comportements démographiques. A cela s'ajoute un guide méthodologique des techniques d'échantillonnage, des principales difficultés et potentialités de la comparaison internationale, des apports de l'analyse longitudinale (panels), de l'organisation des réseaux d'archives, et des principes éthiques qui assurent la protection des données individuelles (Résumé de l'éditeur).
Ministère chargé de la Santé. Direction de la Recherche - des Etudes de l'Evaluation et des Statistiques. (Drees).
Paris : Drees : 2011 : 127 p.
Cet ouvrage présente les principales données relatives au système hospitalier français : elles portent sur les équipements, personnels et financements qui concourent aux différentes prises en charge par les établissements, ainsi que sur leur activité et leur clientèle. Cette édition s'enrichit désormais de dossiers permettant d'approfondir des questions structurelles et d'éclairer les mutations du monde hospitalier. Les fiches thématiques comportent chacune une sélection de figures accompagnées d'un commentaire présentant les traits les plus caractéristiques des domaines abordés.
Jeandel C., Société Française de Gériatrie et Gérontologie. (S.F.G.G.). Syndicat National de Gérontologie Clinique. (S.N.G.C.). Collège National des Enseignants de Gériatrie. (C.N.E.C.G.). Fédération Française des Associations de Médecins Coordonnateurs en EHPAD. (F.F.A.M.C.O.).
Paris : ESV Production : 2011 : 300 p.
Cet ouvrage sur la gériatrie en France, initié par le Collège Professionnel des Gériatres Français, est le fruit du travail des quatres organisations nationales qu'il représente : la Société Française de Gériatrie et Gérontologie, le Collège National des Enseignants de Gériatrie, le Syndicat National de Gérontologie Clinique et de la Fédération Française des Associations de Médecins Coordonnateurs en EHPAD. Les contributions sont réunies autour des thématiques suivantes : les besoins de santé face au vieillissement de la population française, les réponses aux besoins de santé liés au vieillissement, le référentiel métier de la spécialité de gériatrie, résultats d'enquêtes réalisées par les Observatoires Régionaux d'Aquitaine et de Bretagne (sur l'exercice quotidien du gériatre et sur ses activités) et les formations des gériatres.
Giblin B., Amat-Roze J.-M., Lacoste O. et al.
Herodote : Revue de géographie et de géopolitique n° 243 : 2011 : 220 p.
Douze ans après le numéro Santé publique et géopolitique, Hérodote a décidé de reprendre la question de la santé publique. Un double constat s'impose : la santé publique est encore à améliorer, et l'approche territoriale de la santé publique est actée. La loi Hôpital, patients, santé et territoires (HPST) et la création des agences régionales de santé marquent en effet un très grand changement. Pourtant, voilà plus de quinze ans que l'utilité de l'approche géographique pour identifier les réels besoins de soins et de santé était démontrée. Mais les résistances étaient extrêmes. Seule l'aggravation des déficits de plus en plus abyssaux de l'assurance maladie a fini par légitimer l'approche géographique. Si celle-ci est loin de suffire à résoudre les inégalités territoriales de santé, elle peut au moins aider à les identifier. Les choix des priorités et des actions à mener restant de la responsabilité des politiques. La comparaison avec le Royaume-Uni et les États-Unis permet de relativiser la prétention française d'avoir le meilleur système de santé au monde.
Five years after the first Review of Switzerland's health system, the OECD and the World Organization combined their expertise again to report on progress and implementation of health reforms in the Swiss health system. In addition to taking stock of the good overall performance of the Swiss health system, the two organizations propose concrete ways to help the system be more efficient and prepare for the future health needs of the Swiss population. The report focuses on three important issues: health insurance markets, health workforce planning and management and governance of the health system.
Créée par l'Institut des sciences politiques, la chaire Santé a pour objectif de favoriser une approche transversale et pluridisciplinaire des questions de santé au sens large du terme : la santé publique, l'organisation des systèmes de santé, l'assurance maladie et les évolutions du secteur médico-social, etc. Il propose en ligne des cahiers scientifiques qui présentent les travaux réalisés par les chercheurs de la Chaire, une lettre destinée au grand public et des ressources pédagogiques issues d'interventions et de communications.
L'institut Montparnasse est une association loi 1901, crée à l'initiative de la MGEN. Sa mission est de réfléchir aux problématiques concernant la Sécurité sociale en particulier sur quatre grandes thématiques : perspectives de l'Assurance maladie, le financement et la contribution de la Sécurité sociale à l'économie, assurance et société, solidarité et société. Dans ce cadre ses activités recouvrent plusieurs aspects: appel à projets d'études et recherches universitaires ; des partenariats scientifiques avec les structures d'enseignement supérieur et de recherche la mise en place de formations et groupes de travail ; la mise en place de formations et l'animation de groupes de travail ; la réalisation de publications, notes de conjoncture et de veille stratégique, l'organisation de colloques et conférences et-la participation au débat public. Son site présente les thèmes de recherche, le programme des études confiées à des chercheurs universitaires, ses publications et une veille internationale sur les tendances de la protection sociale dans le monde, et des actualités liés à ses thèmes de recherche.
Ce cercle de réflexion indépendant, dirigé par le Dr Philippe Leduc, réunit de façon transversale 26 acteurs et experts du système de soins et de son financement qui souhaitent contribuer à la bonne gestion du système de soins français. La synthèse de ses travaux sera publiée sous forme d'un fascicule de 8 pages largement diffusé auprès des décideurs politiques et du secteur santé. Son blog présente, les temps forts de l'actualité de l'Economie Santé et les débats de la vingtaine d'experts membres du Think Tank Economie Santé. Il expose également ses recommandations issues des réflexions de ses membres.
De Nardi M., French E., Bailey Johns J.
Cambridge : NBER : 2011/12 : 34 p.
This paper describes the Medicaid eligibility rules for the elderly. Medicaid is administered jointly by the Federal and state governments, and each state has significant flexibility on the details of the implementation. It documents the features common to all states, but we also highlight the most salient state-level differences. There are two main pathways to Medicaid eligibility for people over age 65: either having low assets and income, or being impoverished due to large medical expenses. The first group of recipients (the categorically needy) mostly includes life-long poor individuals, while the second group (the medically needy) includes people who might have earned substantial amounts of money during their lifetime but have become impoverished by large medical expenses. The categorically needy program thus only affects the savings decision of people who have been poor throughout most of their lives. In contrast, the medically needy program provides some insurance even to people who have higher income and assets. Thus, this second pathway is to some extent going to affect the savings of the relatively higher income and assets people.
Daidone S., Smith A.
York : University of York : 2011/11 : 26 p.
We were commissioned by the Department of Health's Payment by Results (PbR) team to use 2009/10 data update the analysis we performed using 2008/9 data to estimate the marginal costs of providing specialised care (Daidone and Street, 2011). The objectives of the original work were to investigate: 1. Whether the costs associated with specialised activity are significantly different from nonspecialised activity within the same HRG; 2. Whether any differences in costs between specialised and non-specialised activity are due to differences in productive efficiency. The objective of the update is: 1. To see whether the results obtained on the 2008-09 data are robust to 2009-10 data. 2. To investigate whether there is a case for differentiating payment on the basis of marginal cost differences arising when patients transferred between providers.
Brilleman S.L., Gravelle H., Hollinghurst S. et al.
York : University of York : 2011/11 : 23 p.
This paper investigates the relationship between patients' primary care costs (consultations, tests, drugs) and their age, gender, deprivation and alternative measures of their morbidity and multimorbidity. Such information is required in order to set capitation fees or budgets for general practices to cover their expenditure on providing primary care services. It is also useful to examine whether practices' expenditure decisions vary equitably with patient characteristics. Electronic practice record keeping systems mean that there is very rich information on patient diagnoses. But the diagnostic information (with over 9000 possible diagnoses) is too detailed to be practicable for setting capitation fees or practice budgets. Some method of summarizing such information into more manageable measures of morbidity is required. This paper therefore compared the ability of eight measures of patient morbidity and multimorbidity to predict future primary care costs using data on 86,100 individuals in 174 English practices. The measures were derived from four morbidity descriptive systems (17 chronic diseases in the Quality and Outcomes Framework (QOF), 17 chronic diseases in the Charlson scheme, 114 Expanded Diagnosis Clusters (EDCs), and 68 Adjusted Clinical Groups (ACGs)). We found that, in general, for a given disease description system, counts of diseases and sets of disease dummy variables had similar explanatory power and that measures with more categories did better than those with fewer. The EDC measures performed best, followed by the QOF and ACG measures. The Charlson measures had the worst performance but still improved markedly on models containing only age, gender, deprivation and practice effects. Allowing for individual patient morbidity greatly reduced the association of age and cost. There was a pro-deprived bias in expenditure: after allowing for morbidity, patients in areas in th e highest deprivation decile had costs which were 22% higher than those in the lowest deprivation decile. The predictive ability of the best performing morbidity and multimorbidity measures was very good for this type of individual level cross section data, with R2 ranging from 0.31 to 0.46. The statistical method of estimating the relationship between patient characteristics and costs was less important than the type of morbidity measure. Rankings of the morbidity and multimorbidity measures were broadly similar for generalised linear models with log link and Poisson errors and for OLS estimation. It would be currently feasible to combine the results from our study with the data on the number of patients with each QOF disease, which is available on all practices in England, to calculate budgets for general practices to cover their primary care costs.
Senik C.
Bonn : IZA : 2011/11 : 58 p.
This article sheds light on the important differences in self-declared happiness across countries of equivalent affluence. It hinges on the different happiness statements of natives and immigrants in a set of European countries to disentangle the influence of objective circumstances versus psychological and cultural factors. The latter turns out to be of non-negligible importance in explaining international heterogeneity in happiness. In some countries, such as France, they are responsible for 80% of the country's unobserved idiosyncratic source of (un)happiness.
Fleche S., Smith C., Sorsa P.
Paris : OCDE : 2011 : 39 p.
The paper explores issues with assessing wellbeing in OECD countries based on self-reported life satisfaction surveys in a pooled regression over time and countries, at the country level and the OECD average. The results, which are in line with previous studies of subjective wellbeing, show that, apart from income, the state of health, not being unemployed, and social relationships are particularly important for wellbeing with only some differences across countries. The results also show that cultural differences are not major drivers of differences in life satisfaction. Correlations between the rankings of measures of life satisfaction and other indicators of wellbeing such as the Human Development Index and Better Life Index are also relatively high. Measures of subjective wellbeing can play an important part in informing policy makers of progress with wellbeing in general, or what seems to matter for wellbeing— health, being employed and social contacts- beyond income.
Widmer P.K.
Rochester : Social Science Electronic Publishing : 2011/12 : 23 p.
Several European countries have followed the United States in introducing prospective payment for hospitals with the expectation of achieving cost efficiency gains. This article examines whether theoretical expectations of cost efficiency gains can be empirically confirmed. In contrast to previous studies, the analysis of Switzerland provides a comparison of a retrospective per diem payment system with a prospective global budget and a payment per patient case system. Using a sample of approximately 90 public financed Swiss hospitals during the years 2004 to 2009 and Bayesian inference of a standard and a random parameter frontier model, cost efficiency gains are found, particularly with a payment per patient case system. Payment systems designed to put hospitals at operating risk are more effective than retrospective payment systems. However, hospitals are heterogeneous with respect to their production technologies, making a random parameter frontier model the superior specification for Switzerland.
Gobillon L., Milcent C.
Paris : Paris School of economics : 2011/12 : 8 p.
The role of innovative procedures in the mortality differences between university, non-teaching public and for-profit hospitals is investigated using a French exhaustive administrative dataset on patients admitted for heart attack. Mortality is roughly similar in the three types of hospitals after controlling for case-mix. For-profit hospitals treat the at-risk oldest patients more often with innovative procedures. Therefore, additionnally controlling for innovative procedures makes them having the highest mortality rate. Non-teaching public hospitals end up having the lowest mortality rate.
Widmer P.K., Zweifel P., Farsi M.
Rochester : Social Science Electronic Publishing: 2011 : 29 p.
Several European countries have followed the United States in introducing prospective payment for hospitals with the expectation of achieving cost efficiency gains. This article examines whether theoretical expectations of cost efficiency gains can be empirically confirmed. In contrast to previous studies, the analysis of Switzerland provides a comparison of a retrospective per diem payment system with a prospective global budget and a payment per patient case system. Using a sample of approximately 90 public financed Swiss hospitals during the years 2004 to 2009 and Bayesian inference of a standard and a random parameter frontier model, cost efficiency gains are found, particularly with a payment per patient case system. Payment systems designed to put hospitals at operating risk are more effective than retrospective payment systems. However, hospitals are heterogeneous with respect to their production technologies, making a random parameter frontier model the superior specification for Switzerland.
Cutler D.M., Lleras-Muney A.
Cambridge : NBER : 2012/01 : 30 p.
This review synthesizes what is known about the relationship between education and health. A large number of studies from both rich and poor countries show that education is associated with better health. While previous work has thought of the effect of education separately for rich and poor countries, we argue that there are insights to be gained by integrating the two. For example, education is associated with lower malnutrition in most countries, but in richer countries the educated have lower BMIs whereas in poor countries the educated have higher BMIs. This suggests that the behaviors associated with better health differ depending on the level of development. This paper illustrates this approach by comparing the effects of education on various health and health behaviors around the world, to generate hypotheses about why education is so often (but not always) predictive of health. Finally, it reviews the empirical evidence on the relationship between education and health, paying particular attention to causal evidence and evidence on mechanisms linking education to better health.
Filippini M., Gonzalez Ortiz L.G., Masiero G.
Martigny : RERO : 2011/11 : 23 p.
Because of evidence of causal association between antibiotic use and bacterial resistance, the implementation of national policies has emerged as a interesting tool for controlling and reversing bacterial resistance. The aim of this study is to assess the impact of public policies on antibiotic use in Europe using a differences-in-differences approach. Comparable data on systemic administered antibiotics in 21 European countries are available for a 11-years panel between 1997 and 2007. Data on national campaigns are drawn from the public health literature. We estimate an econometric model of antibiotic consumption with country fixed effects and control for the main socioeconomic and epidemiological factors. Lagged values and the instrumental variables approach are applied to address endogeneity aspects of the prevalence of infections and the adoption of national campaigns. It found evidence that public campaigns significantly reduce the use of antimicrobials in the community by 1.4 to 3.7 defined daily doses per 1000 inhabitants. This roughly represents an impact between 7.2% and 18.5% on the mean level of antibiotic use in Europe between 1997 and 2007. The effect is robust across different measurement methods. Further research is needed to investigate the effectiveness of policy interventions targeting different social groups such as general practitioners or patient.
Brilleman S.L., Gravelle H., Hollinghurst S. et al.
York : University of York : 2011/11 : 23 p.
This paper investigates the relationship between patients' primary care costs (consultations, tests, drugs) and their age, gender, deprivation and alternative measures of their morbidity and multimorbidity. Such information is required in order to set capitation fees or budgets for general practices to cover their expenditure on providing primary care services. It is also useful to examine whether practices' expenditure decisions vary equitably with patient characteristics. Electronic practice record keeping systems mean that there is very rich information on patient diagnoses. But the diagnostic information (with over 9000 possible diagnoses) is too detailed to be practicable for setting capitation fees or practice budgets. Some method of summarizing such information into more manageable measures of morbidity is required. This paper therefore compared the ability of eight measures of patient morbidity and multimorbidity to predict future primary care costs using data on 86,100 individuals in 174 English practices. The measures were derived from four morbidity descriptive systems (17 chronic diseases in the Quality and Outcomes Framework (QOF), 17 chronic diseases in the Charlson scheme, 114 Expanded Diagnosis Clusters (EDCs), and 68 Adjusted Clinical Groups (ACGs)). We found that, in general, for a given disease description system, counts of diseases and sets of disease dummy variables had similar explanatory power and that measures with more categories did better than those with fewer. The EDC measures performed best, followed by the QOF and ACG measures. The Charlson measures had the worst performance but still improved markedly on models containing only age, gender, deprivation and practice effects. Allowing for individual patient morbidity greatly reduced the association of age and cost. There was a pro-deprived bias in expenditure: after allowing for morbidity, patients in areas in th e highest deprivation decile had costs which were 22% higher than those in the lowest deprivation decile. The predictive ability of the best performing morbidity and multimorbidity measures was very good for this type of individual level cross section data, with R2 ranging from 0.31 to 0.46. The statistical method of estimating the relationship between patient characteristics and costs was less important than the type of morbidity measure. Rankings of the morbidity and multimorbidity measures were broadly similar for generalised linear models with log link and Poisson errors and for OLS estimation. It would be currently feasible to combine the results from our study with the data on the number of patients with each QOF disease, which is available on all practices in England, to calculate budgets for general practices to cover their primary care costs.
Ryan P.
Rochester : Social Science Electronic Publishing : 2011/12 : 64 p.
Ireland's health system is at a key turning point. The Irish government was newly elected in February 2011, and the policy directions adopted over the coming months will likely exert a major impact on system performance for many years. Drawing on recent international experience with performance measurement and financial incentives, this paper examines strategies for enhancing quality and value in the Irish health system, focusing predominantly on the role of primary care.Three take-home messages emerge from the literature. First, substantial improvements in quality of care often can be attained at a reasonable cost, such as through the use of checklists and evidence-based clinical pathways, or by better aligning the skills of health care providers to patients' need. Second, rigorous performance measurement is a vital tool for quality improvement that is lacking in Ireland, and this could be particularly powerful if underpinned by risk-adjustment to enable reliable evaluation of clinical outcomes. Pilot projects are required to examine the feasibility of these techniques in the Irish context. Third, although pay-for-performance is a prominent quality improvement strategy, little evidence exists to support its purported benefits and it can exert negative effects. Incentives are unlikely to be effective if providers lack the capability to respond appropriately, therefore it is imperative to foster professionalism and pride in high-quality care, and to develop the managerial and clinical skills necessary for high performance.
Godager G., Wiesen D.
Oslo : HERO : 2011 : 16 p.
This paper investigates physician altruism toward patients' health benefit using behavioral data from the fully incentivized laboratory experiment of Hennig-Schmidt et al. (2011). This setup identifies both physicians' profits and patients' health benefit resulting from medical treatment decisions. It estimates a random utility model applying multinomial logit regression, finding that physicians attach a positive weight on patients' health benefit. Furthermore, physicians vary substantially in their degree of altruism. Finally, we provide some implications for the design of physician payment schemes.
Walendzik A.
Essen : Institut für Betriebswirtschaft und Volkswirtschaft. (I.B.E.S.). : 2011/11 : 109 p.
In Germany as in most countries, risk adjustment up to now has mainly been used between health funds. The aim is to avoid risk selection in order to use competition of health funds to improve efficiency and effectiveness in health care. As a recent development, in 2009 - together with the introduction of the German Health Fund - a morbidity based risk adjustment scheme to distribute resources between the about 180 competing social health funds has been installed. But in the same year, the reform of the remuneration system of physicians in outpatient care depicted a second field of implementation of risk adjustment in the German social health care system introducing some forms of risk adjustment in this context as well. Changes in morbidity of the patient population have to be measured since then and, fulfilling a long-term claim of physicians, morbidity risk was transferred from physicians to statutory health funds. As legal regulations of the reform left space for interpretation, discussions about purposes and potential implementation fields of risk adjustment in the remuneration system for outpatient medical care have been triggered. An important question from an economic point of view is Can the remuneration system for outpatient medical care in Germany be improved by including risk adjustment? This dissertation tries to enrich the discussion about the role of risk adjustment in the German outpatient remuneration system by providing new methodological solutions in the use of a diagnoses based classification system as well as an analysis of the conditions for their use under the specific German conditions.
Thomas D., Weegen L., Walendzik A.
Essen : Institut für Betriebswirtschaft und Volkswirtschaft. (I.B.E.S.). : 2011 : 257 p.
The organisation of primary eye care services in Europe is not uniform. While in some countries primary eye care is exclusively within the scope of practice of ophthalmologists, other systems rely on a variety of different professions providing essential parts of primary eye and vision health care. The study at hand addresses the question whether costs and outcomes of primary eye care services differ between heterogeneously organised systems. Therefore a special focus on the participation of opticians and optometrists was set. Having similar populations and economic conditions, but differently organised eye care systems, the countries France, Germany and the UK were exemplarily analysed as target countries. Based on an initial description of the different primary eye care systems, a criteria-based evaluation of costs and outcomes was conducted. Information was gained by expert-interviews and a systematic literature search in the Scorpus database alongside with unsystematic Internet searches.
Prada S.I., Gonzalez C., Borton J. et al.
Munich : Munich Personal RepEc Archive : 2011/12 : 16 p.
Achieving data and information dissemination without arming anyone is a central task of any entity in charge of collecting data. This article examines the literature on data and statistical confidentiality. Rather than comparing the theoretical properties of specific methods, they emphasize the main themes that emerge from the ongoing discussion among scientists regarding how best to achieve the appropriate balance between data protection, data utility, and data dissemination. They cover the literature on de-identification and rei-dentification methods with emphasis on health care data. The authors also discuss the benefits and limitations for the most common access methods. Although there is abundant theoretical and empirical research, their review reveals lack of consensus on fundamental questions for empirical practice: How to assess disclosure risk, how to choose among disclosure methods, how to assess reidentification risk, and how to measure utility loss.
Hackmann M.B., Kolstad J.T., Kowalski A.E.
Cambridge : NBER : 2012/01 : 6 p.
This paper implements an empirical test for selection into health insurance using changes in coverage induced by the introduction of mandated health insurance in Massachusetts. Our test examines changes in the cost of the newly insured relative to those who were insured prior to the reform. We find that counties with larger increases in insurance coverage over the reform period face the smallest increase in average hospital costs for the insured population, consistent with adverse selection into insurance before the reform. Additional results, incorporating cross-state variation and data on health measures, provide further evidence for adverse selection.
Botti F., Corsi M., D'Ippoliti C.
Bruxelles : Université libre de Bruxelles : 2011 : 23 p.
Active ageing strategies have so far strongly focused on increasing senior workers employment rates through pension reforms to develop incentives to retire later on the one hand, and labour market policies on the other hand. Most measures are based on the dominant male trajectory of work and retirement and they are not explicitly gender mainstreamed. By contrast, a gender approach would prove fundamental to the labour market inclusion of elderly people, because in old age women suffer from the accumulated impact of the barriers to employment they encountered during their lifetime (e.g., repeated career breaks, part-time work, low pay and gender pay gap). Moreover, it appears that some pension reforms, by mandating a higher postponement of retirement and by establishing tighter links between formal employment and pension benefits may negatively affect the already high risk of poverty for elderly women.
Lundborg P., Nilsson M., Vikstrom J.
Uppsala : Uppsala Center for Labor Studies : 2011 : 42 p.
This paper estimates socioeconomic heterogeneity in the effect of unexpected health shocks on labor market outcomes, using register-based data on the entire population of Swedish workers. It effectively exploits a Difference-in-Difference-in-Differences design, in which it compares the change in labor earnings across treated and control groups with high and low education levels. If the anticipation effects are similar for individuals with high and low education, any difference in the estimates across socioeconomic groups could plausibly be given a causal interpretation. The results suggest a large amount of heterogeneity in the effects, in which individuals with a low education level suer relatively more from a given health shock. These results hold across a wide range of different types of health shocks and become more pronounced with age. The results suggest that socioeconomic heterogeneity in the effect of health shocks offers one explanation for how the socioeconomic gradient in health arises.