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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Retirement intentions, health and satisfaction at work:a European comparison
Questions d'économie de la santé n° 103. December 2005.
Blanchet D., Debrand T.

According to the SHARE 2004 Survey in 10 European countries, 57% of the French population aged between 50 and 59 who are still in employment would like to retire as soon as possible, compared to 31% of the Dutch population.
Two factors which may explain this wish for early retirement are working conditions and health status. In the group of countries studied, good or very good declared health status reduced the probability of wishing to retire as soon as possible by 5.5 points. Being satisfied overall with work reduced it by 14.2 points. But the preference for early retirement varies considerably between countries, even when health status and working conditions are the same.

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The politics of drug reimbursement in England, France and Germany
Questions d'économie de la santé n° 99. October 2005.
N'Guyen L., Or Z., Paris V. , Sermet C.

Pharmaceutical expenditure, which has doubled during the last ten years, is a major concern in France, as in most other industrialised countries. However, France stands out for its level of expenditure: twice as high as in England and one and half times higher than in Germany. All these countries use specific lists defining the drugs that are reimbursed by public funds (positive list) or not taken in charge (negative list) to control their drug expenditures. Do these lists have any impact on the extent of reimbursement? And does the content of the drug baskets explain the differences in consumption between these countries?
Three categories of drugs for which these countries have adopted different strategies are studied: benzodiazepines, vasodilators and life style drugs (obesity, tobacco addiction etc.). It seems that the size of the drug basket reimbursed is independent of the positive or negative nature of the list. Moreover, these examples reveal that it is not the number of products available in the basket that explains the variations of drug expenditure between the countries, but the differences in doctors' prescription behaviour. The experiences of our neighbours suggest that it is important to put in place tools for controlling drug demand including in particular, financial incentives for more rational prescription and consumption. This is shown by England's experience, which, in contrast to the other countries, reimburses anti obesity and smoking cessation drugs yet manages to control its overall drug expenditure.

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Are measures of health and economic activity comparable in european surveys?
Questions d'économie de la santé n° 96. June 2005.
Barnay T., Jusot F. , Rochereau T. , Sermet C.

The employment of older workers is now a key social issue, and varies widely in Europe. Its development is closely related to health status, which is not uniform across Europe either. To understand these differences we need comparable data. Do the surveys we currently have in Europe enable us to carry out these analyses? Which measures of health and of economic activity are actually comparable in the national surveys carried out recently in ten European countries?
Five measures of health status meet the criteria of adequate comparability and are available in at least eight of the ten countries studied: self-perceived health, certain self-reported illnesses, anthropometric measures, certain restrictions in activities of daily living, and daily cigarette consumption. Furthermore, three measures of economic activity are comparable: employment status in all of the surveys (active, inactive and retired), occupational status (salaried or independent) and hours worked daily. The comparative analysis of self-perceived health, Body Mass Index and cigarette consumption shows that international variations in health status are closely related to the indicator selected.

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The participation of nurses in primary care in six European countries, Ontario and Quebec
Questions d'économie de la santé n° 95. June 2005.
Bourgueil Y., Marek A., Mousquès J.

In France, the forecast decline in the number of doctors and problems already evident in their distribution across the country has prompted debate on the division of labour among professionals, something which is already being put into practice in other countries facing similar problems.
Changes in the organisation and distribution of different professional activities can go some way towards solving problems of medical demography: the extension of skills, and the creation of new qualifications or even professions, are also approaches being debated and explored within this experimental area of cooperation between health professions.
The objective of this study is to examine ways in which other countries, in Europe in particular, define the roles and competencies of health professionals, notably nurses. The study examines the ambulatory care sector, also known as primary care, with its connotations of accessibility, point of first contact and continuity of care, even if these aspects of primary care require further elaboration and specification. It seems that the ambulatory care sector will be most affected by these changes in the future, given the need for accessibility to these services, and the potential for change in this area. In fact it is prinicipally in this care sector that there is most potential for developing health prevention and education services, or new functions such as care coordination.

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Policies for reducing inequalities in health, what role can the health system play? A European perspective
Part II: Experience from Europe

Questions d'économie de la santé n° 93. February 2005.
Couffinhal A. (WorldBank), Dourgnon P. (Irdes),Geoffard P.-Y. (PSE), Grignon M. (McMaster University), Jusot F. (Irdes), Lavis J. (McMaster University), Naudin F. (CETAF), Polton D. (Irdes).

In recent years, a number of European countries have elaborated organized strategies for reducing inequalities in health, notably the United Kingdom, the Netherlands and Sweden. Some of them, like the United Kingdom, have defined quantifiable objectives for the year 2010. Other countries, like the Netherlands, have embarked on a programme of local experiments with rigorous evaluations. In all three, work is underway to measure the effectiveness of these interventions and provide pertinent information to political decision-makers.
Drawing on research which suggests that a reduction in inequalities in health undoubtedly requires a reduction in overall economic and social inequalities, the different strategies undertaken in these three countries contain elements intended to influence the social determinants of health inequalities outwith the healthcare system. They also involve actions designed to mobilize the healthcare system, notably through preventive health measures and primary healthcare.

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Policies for reducing inequalities in health, what role can the health system play? A European perspective
Part I: Determinants of social inequalities in health and the role of the healthcare system

Questions d'économie de la santé n° 92. February 2005.
Couffinhal A. (WorldBank), Dourgnon P. (Irdes),Geoffard P.-Y. (PSE), Grignon M. (McMaster University), Jusot F. (Irdes), Lavis J. (McMaster University), Naudin F. (CETAF), Polton D. (Irdes).

In many countries, social inequalities in health persist and in some cases are increasing. Various hypotheses have emerged from research on the factors which may explain these inequalities: related to living conditions, high-risk lifestyles and inverse cause and effect whereby differences in state of health themselves induce differences in earning capacity. A more recent avenue of research points to the existence of a direct effect of social hierarchy or structure on health.
In contemporary research on social inequalities in health, the role played by the healthcare system has been somewhat neglected. This is partly due to a widely accepted notion that the impact of healthcare on health status is relatively insignificant and particularly to the finding that inequalities have persisted or worsened in countries which have adopted a system of open and free access to healthcare. Nevertheless, a number of mechanisms can lead to differences in real access to care thereby reinforcing existing inequalities, as has been shown in several empirical studies.

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The development of hospital care at home:an investigation of Australian, British and Canadian experiences
Questions d'économie de la santé n° 91. December 2004.
Chevreul K., Com-Ruelle L., Midy F., Paris V.

In France, the development of hospital care at home (abbreviated by French acronym SHAD) offering an alternative to traditional hospital-based care does not measure up to the scope of its possibilities, such as enhancing the quality of the care and improving the coordination between the ambulatory and hospital care. Examination of experiences in other countries of these modes of care would help to understand their context and the factors which facilitate or hinder their development. The aim of this analysis is to contribute to the debate on the appropriateness of maintaining and extending this type of services in France.
Three countries were chosen for their large amount of available literature on the subject of home health care: Australia, Canada and the UK. Their experiences show that the type of pressure exerted on the supply of hospital services determines the development and characteristics of home health care. Nevertheless, their development must be encouraged by an assertive policy which creates the right incentives, in terms of financing, inter-sectoral coordination and the organisation of the care as well as the acceptability of the programmes.