WORKING PAPERS 2007

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Psychosocial resources and social health inequalities in France: Exploratory findings from a general population survey
Jusot F., Grignon M., Dourgnon P.
Irdes working paper n° 6. 2007/09.

We study the psychosocial determinants of health, and their impact on social inequalities in health in France.
We use a unique general population survey to assess the respective impact on self-assessed health status of subjective perceptions of social capital controlling for standard sociodemographic factors (occupation, income, education, age and gender). The survey is unique for two reasons: First, we use a variety of measures to describe self-perceived social capital (trust and civic engagement, social support, sense of control, and self-esteem). Second, we can link these measures of social capital to a wealth of descriptors of health status and behaviours.
We find empirical support for the link between the subjective perception of social capital and health. Sense of control at work is the most important determinant of health status. Other important ones are civic engagement and social support. To a lesser extent, sense of being lower in the social hierarchy is associated with poorer health status. On the contrary, relative deprivation does not affect health in our survey. Since access to social capital is not equally distributed in the population, these findings suggest that psychosocial factors can explain a substantial part of social inequalities in health in France.

Published in: Health Economics Policy and Law, vol 3, n° 4, 2008/10, 365-391.
Access to Psycho-Social Resources and Health : Exploratory Findings from a Survey of the French Population.
Jusot F., Grignon M., Dourgnon P.

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Observatory of self-employed doctor practices Results from the survey 2006 - « Group practice of Brittany GPs »
Beauté J., Bourgueil Y., Mousquès J. (Irdes) Bataillon R., Samzun J.L.(Urml Bretagne), Rochaix L. (HAS).
Irdes working paper n° 6. 2007/08.

Considering the new epidemiological issues (chronic diseases), the medical supply shortage attended and the increasing requirement in terms of quality and efficiency of the care, numerous authors were in favor of a strengthening of primary care. Grouping together doctors in group practices is on line with this position. He would indeed allow, by grouping together resources, to improve the quantity and the quality of the care and services delivered. However, we have only few data concerning group practices in France. More information is necessary to consider the possible implementation of incentive policies.
This study general objective is to identify possible levers of a public policy in favor of the development of practice in group in France. This study specific objective is to describe characteristics of GPs working in group - specifically regarding their motivations to practice so -, by comparison to GPs working in solo. A questionnaire was sent to a sample of 120 self-employed general practitioners practicing in Brittany during the summer 2006. This questionnaire gathers information relative to the GPs and their practices. The response rate was around 80% and the sample includes 60% of GPs working in group (59/96).
The doctors practicing in group are younger and have more children than those working in solo. The motivations for practicing in group are more a matter of professional quality of life by sharing resources than a way to improve the quality of the care delivered. Then, groups are well equipped than the solo practices, whether it is at the level of the IT either medical equipment, and also offer larger days of openings and openings hours than the solo practices.
The current scope of practicing in group seems attractive for GPs. It also seems to improve the care accessibility and the quantity of the care and services delivered to the patients. The implementation of financial incentives for grouping together GPs without counterparts such as the obligation to supply certain services to the population (disease management for example) or without combine incentives to develop team work between professionals could generate windfall effect for GPs without supplementary benefits for the population.

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Sickness and injury leave in France : moral hazard or strain? 
Grignon M. (McMaster University), Renaud T. (Irdes).
Irdes working paper n° 4. 2007/02.

From 1997 to 2001, the total payment to compensate for sickness and injury leaves increased dramatically in France. Since this change coincided with a decrease in unemployment rate, three hypothesizes should be proposed as possible explanations consistently with the literature: moral hazard (workers fear less to loose their job, therefore use sickness leave more confidently); strain (workers work longer hours or under more stringent rules); labor-force composition effect (less healthy individuals are incorporated into the labor force).
We investigate the first two strands of explanation using a household survey (ESPS) enriched with claims data from compulsory health insurance funds on sickness leaves (Epas). We model separately number of leaves per individual (cumulative logit) and duration of leaves (random-effect model).
According to our findings, in France, the individual propensity to take sickness leave is mainly influenced by strain in the workplace and by a labor-force composition effect. Conditional duration of spells is not well explained at the individual level: the only significant factor is usual weekly work duration. Influence of moral hazard is not clearly ascertained: it has few impact on occurrences of leave and no impact on duration.

Published in: Revue d'Epidémiologie et de Santé Publique, vol 55, n° 4, 2007/08, 243-251.
Moral Hazard, Doctors, and Absenteism in France. Preliminary Analysis Based on Aggregate Data.
Grignon M., Renaud T.

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Work organization and health of seniors citizens in Europe
Debrand T. (Irdes), Lengagne P. (Irdes).
Irdes working paper n° 3. 2007/02.

Working conditions have greatly evolved in recent decades in developed countries. This evolution has been accompanied with the appearance of new forms of work organisation that may be sources of stress and health risk for older workers. As populations are ageing, these issues are particularly worrying in terms of the health, labour force participation and Social Security expenditure.
This paper focuses on the links between quality of employment and the health of older workers, using the Share 2004 survey. Our research is based on two classical models: the Demand-Control model of Karasek and Theorell (1991) and the Effort-Reward Imbalance model of Siegrist (1996), which highlight three main dimensions: Demand that reflects perceived physical pressure and stress due to a heavy work load; Control that refers to decision latitude at work and the possibilities to develop new skills; and Reward that corresponds to the feeling of receiving a correct salary relatively to efforts made, of having prospects for personal progress and receiving deserved recognition. These models also take into account the notion of support in difficult situations at work and the feeling of job security.
Our estimations show that the health status of older workers is related to these factors. Fairly low demand levels and a good level of reward are associated with a good health status, for both men and women. Control only influences the health status of women. Lastly, the results reveal the importance on health of a lack of support at work and the feeling of job insecurity; regardless of gender; these two factors are particularly related to the risk of depression. Thus health status and working conditions are important determinants of the labour force participation of older workers.

Published in: Economie et Statistique, n° 403-404, 2007/12, 19-38.
Pénibilité au travail et santé des seniors en Europe.
Debrand T., Lengagne P.

Which gave rise to: Questions d'économie de la santé Irdes n° 120, 2007/03.
Pénibilité au travail et santé des seniors en Europe.
Debrand T., Lengagne P.

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Les comparaisons internationales d'état de santé subjectif sont-elles pertinentes ? Une évaluation par la méthode des vignettes-étalons
Lardjane S. (CREST-ENSAI, Laboratoire de Statistique d'Enquêtes), Dourgnon P. (Irdes).
Document de travail Irdes n° 2. 2007/02.

Lorsque les modalités de réponse à une question de santé subjective sont utilisées différemment par différents individus, on dit que celles-ci sont affectées d'un effet DIF. Nous présentons une méthode non-paramétrique de détection et de correction de tels effets dans les auto-évaluations de santé subjective. Nous illustrons cette méthode par la mise en évidence d'un effet DIF potentiel dans le cas de l'auto-évaluation du niveau de douleur physique ressenti par des personnes âgées issues de différents pays européens et montrons comment le prendre en compte dans l'analyse statistique.

Paru dans : Economie et Statistique, n° 403-404, 2007/12, 165-177.
Les comparaisons internationales d'état de santé subjectif sont-elles pertinentes ? Une évaluation par la méthode des vignettes-étalons.
Lardjane S., Dourgnon P.

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Preference for Early Retirement, Health and Job Satisfaction: a European Comparisone
Blanchet D. (Insee- Département des Etudes Economiques d'Ensemble), Debrand T. (Irdes).
Irdes working paper n° 1. 2007/02.

This work uses the first wave of SHARE to analyze the impact of health and satisfaction at work on preferences concerning age at retirement in 10 European countries. Preferences concerning age at retirement are measured by the rate of people wishing to retire as soon as possible. We examine how health and work conditions contribute to explain differences in these preferences both at the individual level and between countries. At the individual level, the effects that are obtained are consistent with expectations, but they are of little help for explaining international differences. Fixing health and work conditions, we observe a north-south gradient of preferences for early retirement which remains close to the gross cross country differentials. All these results are robust to control by institutional features of pension systems (overall generosity of pension systems) and to control for the selection bias implied by the fact that preferences are only measured on people that are still in employment.

Published in: Economie et Statistique, 403-404, 2007/12, 39-62.
Souhaiter prendre sa retraite le plus tôt possible : santé, satisfaction au travail et facteurs monétaire.
Blanchet D., Debrand T.

Which gave rise to: Issues in Health Economics (Questions d'économie de la santé) n° 103. 2005/12.
Retirement intentions, health and satisfaction at work:a European comparison.
Blanchet D., Debrand T.

Which gave rise to: Insee Première, n° 1052, 2005/12, 1-4.
Aspiration à la retraite, santé et satisfaction au travail : une comparaison européenne.
Blanchet D., Debrand T.