IRDES Newsletter

Harkness Fellowship

The Commonwealth Fund is currently inviting applications for its Harkness Fellowships in Health Care Policy and Practice, providing a unique opportunity for mid-career health services researchers and practitioners to spend up to 12 months in the United States, conducting original research and working with leading U.S. health policy experts.

Two IRDES researchers have been awarded the Harkness Fellowship: Julien Mousquès in 2015 and Paul Dourgnon in 2016.

Deadline for receipt of applications: 13 November 2017

 More information on the Commonwealth website

Reminder

17^th International Medical Geography Symposium (IMGS 2017)

The International Medical Geography Symposium is the leading international meeting of health and medical geographers. Every two years, the symposium welcomes health geographers and others interested in applying a spatial approach to their research to share findings and form new ideas about the progress of this exciting sub-discipline.
The 17^th IMGS will take place in France in July 2-7, 2017, hosted by the University of Angers. The organizing committee, of which IRDES is a member, welcomes all those interested in health geography to attend this conference. The theme of this edition is "Practicing health and medical geography in 2017". Papers and posters presented at the conference will deal with a variety of health issues, including: social perspectives on health; health policy; health care and services; ageing; urban health; rural health; environment and health; GIS approaches; global health; health human resources and health inequities and inequalities.

 Presentation

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?

Sirven N. (LIRAES (EA 4470), Université Paris Descartes, and IRDES)

Issues in Health Economics (224), March 2017

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.

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)

Pisarik J. (DREES), Rochereau T. (IRDES), In collaboration with Célant N. (IRDES)

Issues in Health Economics (223), March 2017

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.

Compulsory Psychiatric Treatment: An Assessment of the Situation Four Years after the Implementation of the Act of 5 July 2011

Coldefy M. (Irdes), Fernandes S. (ORU-Paca, Université Aix-Marseille), In collaboration with Lapalus D. (ARS Paca)

Issues in Health Economics (222), February 2017

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.

Use of Outpatient Care and Distances Travelled by Patients: Significant Differences in Regional Access to Healthcare

Com-Ruelle L., Lucas-Gabrielli V., Pierre A. (Irdes), In collaboration with Coldefy M. (Irdes)

Issues in Health Economics (219), June 2016

In France, the provision of medical care is on a par with the OECD (Organisation for Economic Cooperation and Development) countries' average, but it is unequally distributed across the territory. Doctors are mainly concentrated in urban areas, metropolises, and coastal regions. Inequalities in the provision of outpatient care are very pronounced when measured by the Local Potential Accessibility indicator (indicateur d'Accessibilité Potentielle Localisée, or APL), which assesses the adequacy between care provision and demand, at the municipal level.

Based on the 2010 Health, Health Care and Insurance Survey (Enquête santé et protection Sociale, or ESPS), conducted by the French Institute for Research and Information in Health Economics (IRDES), and matched with the administrative healthcare consumption data, this study highlights differences in outpatient care use, in terms of rates of utilisation, access to the closest doctor, and additional distances travelled by patients. The analysis takes into account patients' individual characteristics and three indicators related to territorial access to healthcare.

The results show that reduced outpatient care availability leads patients to make more frequent journeys, that is to say to use the closest form of healthcare less often. However, they are less prone to travel additional distances further than the closest doctors when they are located far from their places of residence, which limits their freedom of choice.

Frailty, Polypharmacy, and Potentially Inappropriate Medications in Old People: Findings in a Representative Sample of the French Population

Herr M., Sirven N., Grondin H., Pichetti S., Sermet C., European Journal of Clinical Pharmacology, Online: 11/06/2017, 1 -8.

Gatekeeping and the Utilization of Physician Services in France: Evidence on the 'Médecin traitant Reform'

Dumontet M., Buchmueller T., Dourgnon P., Jusot F., Wittwer J. , Health Policy, vol 121, Issue 6, 2017/06, 675-682.

Changes in Smoking Behavior over Family Transitions: Evidence for Anticipation and Adaptation Effects

Bricard D., Legleye S., Khlat M. International Journal of Environmental Research and Public Health, vol 14, n° 6, 2017/06, 1-10.

Risk Analyses of Pressure Ulcer in Tetraplegic Spinal Cord-Injured Persons: A French Long-Term Survey

Le Fort M., Espagnacq M., Perrouin-Verbe B., Ravaud J.-F. Archives of Physical Medicine and Rehabilitation. Online: 25/01/2017.

Optimizing Comparisons of PHC Systems: An Example Comparing Switzerland and France with a Standard Monitoring Tool

Giller B., Cartier T., Ebert S.T., Bourgueil Y., Cornuz J., Senn N. Praxis : Revue suisse de la médecine, 106 (7), 2017: 373-379.

... Thierry Rochereau on the occasion of the publication of Issues in Health Economics (223), March 2017: "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)", in collaboration with Pisarik J. (DREES) and Célant N. (IRDES)

• What about the health status of the French population? What inequities do you observe?
• Who is the most affected by depression in France?
• How does France compare with other European countries in terms of smoking and overweight?

Read the interview