WP n° 37
Despite common recommendations and quasi universal health care coverage in all European countries, there are large differences in the utilisation patterns of different health services. Little comparative information is available on different types of health service utilisation and variations in utilisation patterns over a longer time span. The objective of this study is to compare and investigate individual and cross-country determinants of health care utilisation habits over the life span across European countries. We found that while there is a general shift toward more regular and preventive care utilisation in all countries; there are still signifi cant social inequalities between countries and cohorts. There is also evidence that once the individual effects have been isolated, cross-cohort and country differences in the prevalence of regular care use are partly associated with differences in welfare states interventions.
Published in: The Individual and the Welfare State. Life Histories in Europe in Borsch-Supan A., Brandt M., Hank K. & Schroder M. (Eds), Springer: Heidelberg. 2011, 241-254.
WP n° 36
Affordability of Complementary Health Insurance in France: A social experiment
We developed a controlled experiment with the National Health Insurance Fund in order to test whether this low take-up rate is due to the current financial aid being insufficient or whether it is explained by a lack of information on the application process. Three groups of eligible households living in an urban area in the north of France were randomly selected: a control group benefiting from the current financial aid, a group benefiting from a 75% voucher increase, and a last group benefiting from a 75% voucher increase and invitation to an information meeting on ACS.
Six months after experiment started, we observe a small but positive effect of the voucher increase on ACS take-up. Surprisingly, both treatments, the invitation to a briefing and the voucher increase, seem to cancel each other out. However, attending the briefing has a positive and significant impact on ACS take-up. Thus, this study confirms that ACS is complicated and hardly hits its target. Moreover, CHI beneficiaries and non-beneficiaries don't respond differently to treatments, which suggests that the central issue of ACS low take-up rate is not the CHI cost itself but most certainly that of the access to information, the cost and the complexity of the application process.
Published in: Rapport final de l'appel à projet d'expérimentations sociales 2008 du Haut Commissariat aux solidarités actives contre la pauvreté. 2010.
Which gave rise to: Issues in Health Economics (Questions d'économie de la santé) n° 162, 2011/02.
Wich gave rise to: Document de travail Leda-Legos, WP n° 7/2011, Le recours à l'Aide complémentaire santé : les enseignements d'une expérimentation sociale à Lille, 2011 Guthmuller S., Jusot F., Wittwer J. en collaboration avec Desprès C.
WP n° 35
Adverse selection, which is well described in the theoretical literature on insurance, remains relatively difficult to study empirically. The traditional approach, which focuses on the binary decision of “covered” or “not”, potentially misses the main effects because heterogeneity may be very high among the insured. In the French context, which is characterized by universal but incomplete public health insurance (PHI), we study the determinants of the decision to subscribe to supplemental health insurance (SHI) in addition to complementary health insurance (CHI). This work permits to analyze health insurance demand at the margin. Using a panelized dataset, we study the effects of both individual state of health, which is measured by age and previous individual health spending, and timing on the decision to subscribe. One striking result is the changing role of health risk over time, illustrating that adverse selection occurs immediately after the introduction of SHI. After the initial period, the effects of health risks (such as doctors' previous health expenditures) diminish over time and financial risks (such as dental and optical expenses and income) remain significant. These results may highlight the inconsistent effects of health risks on the demand for insurance and the challenges of studying adverse selection.
Which gave rise to: Issues in Health Economics (Questions d'économie de la santé) n° 150. 2010/01.
WP n° 34
Using the microsimulation model ARAMMIS, this study attempts to measure the impacts of introducing an out-of-pocket (OOP) maximum threshold, or a safety net threshold, on consumer copayments for health care financed by the abolition of the Long-term Illness Regime (ALD) in France. The analysis is based on a comparison of different safety net threshold rules and their redistributive effects on patients' OOP payments.
Which gave rise to: Issues in Health Economics (Questions d'économie de la santé) n° 159. 2010/11.
WP n° 33
Effort or Circumstances: Does the Correlation Matter for Inequality
of Opportunity in Health?
This paper proposes a method to quantify the contribution of inequalities of opportunities and inequalities due to differences in effort to be in good health to overall health inequality. It examines three alternative specifications of legitimate and illegitimate inequalities drawing on Roemer, Barry and Swift's considerations of circumstances and effort. The issue at stake is how to treat the correlation between circumstances and effort. Using a representative French health survey undertaken in 2006 and partly designed for this purpose, and the natural decomposition of the variance, the contribution of circumstances to inequalities in self-assessed health only differs of a few percentage points according to the approach. The same applies for the contribution of effort which represents at most 8%, while circumstances can account for up to 46%. The remaining part is due to the impact of age and sex.
Published in: Bulletin Epidémiologique Hebdomadaire, Numéro thématique – Inégalités sociales de santé, 2011/03/08, 8-9 : 96-98.
Published in: Cahiers de la Chaire Santé n° 8, 2010/10, 36 p.
Published in: Health Economics, vol. 19, n° 8, 2010/08. 921-938.
Which gave rise to: Issues in Health Economics (Questions d'économie de la santé)
Published in: Working Papers 08/24, Health, Econometrics and Data Group (HEDG), c/o Department of Economics, University of York. 2008/10.
WP n° 32
OOP Safety Net Threshold: A Choice between Equality and Equity? An Analysis using the ARAMMIS model
Which gave rise to: Issues in Health Economics (Questions d'économie de la santé) n° 159. 2010/11.
WP n° 31
This document is superseded:
Explaining Price Discrepancies between Me-Too Drugs and the First-In-Class
Results show that in a group, me-too drugs are on average 59% more costly than firstin-class. In a given group, more innovation is associated with higher price gaps. On the contrary, arrival of generic drugs on the market or the fact that drugs are included in reference price groups (so-called “Tarif Forfaitaire de Responsabilité” [TFR] in France) tend to reduce the price gaps between me-too drugs and first-in-class. For those drugs that are available in several dosages, monotonic pricing, i.e. a price which is proportional to dosage, leads to higher price discrepancies and can be considered as unfair for patients who have to buy higher dosages. Finally, price gaps increase with drugs market shares, which contrasts with the price rule announced by the regulator.
WP n° 30
Monitoring Health Inequalities in France: A Short Tool for Routine Health Survey to Account for LifeLong Adverse Experiences
Conventional health surveys focus on current health and social context but rarely address past experiences of hardship or exclusion. However, recent research shows how such experiences contribute to health status and social inequalities. In order to analyse in routine statistics the impact of lifelong adverse experiences (LAE) on various health indicators, a new set of questions on financial difficulties, housing difficulties due to financial hardship and isolation was introduced in the 2004 French National health, health care and insurance survey (ESPS 2004).
Published in: European Journal of Public Health.
Published in: Rapport Irdes n° 1621, Santé, soins et protection sociale en 2004.
WP n° 29
Effect of a French Experiment of Team Work between General Practitioners and Nurses on Efficacy and Cost of Type 2 Diabetes Patients Care
This study aims to assess the efficacy and the cost of a French team work experiment between nurses and GPs for the managing of type 2 diabetes patients. Our study was based on a case control study design in which we compare the evolution of process (standard follow-up procedures) and final outcomes (glycemic control), and the evolution of cost. The study is realized for two consecutive periods between type 2 diabetes patients followed within the team work experiment (intervention group) or by “standard” GPs (controlled group).
After 11 months of follow-up, we showed that patients in the intervention group, compared with those in the controlled group, have more chances to remain or to become: correctly followed-up (with OR comprise between 2.1 to 6.8, p<=5%) and under glycemic control (with OR comprise between 1.8 to 2.7, p<=5%). The latter result is obtained only when a visit for education and counselling has been delivered by a nurse in supplement to systematic electronic patient registry and electronic clinical GPs reminder. All these results are obtained without difference in costs between the intervention and the controlled groups.
Finally, this experimentation of team working can be considered both effective and efficient. Our findings may have implications in the design of future larger primary care team work experiments to be launched by French health authorities.
* Irdes, Prospère
Published in: Health Policy, vol 98, n° 2-3, 2010/12, 131-143.