IRDES Newsletter

First Steps Survey

The First Steps Survey (Enquête Premiers pas) is part of a research project on the paths of access to rights and healthcare for undocumented immigrants. The field research started on March 4, 2019.

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European Health Interview Survey: EHIS 2019

The Directorate for Research, Studies, Assessment and Statistics (French Ministry of Health) and IRDES are carrying out a major statistical survey on the health of the French population, from 9 April to 8 July 2019 and from early September to mid-December 2019.

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Cooperation between general practitioners and nurses

Following the publication of the second Issues in Health Economics on the experimental project named "Team Health Project in Private Practice" (Action de Santé Libérale En Équipe, ASALÉE), let us explore one of the research themes studied for years at IRDES, namely the coordination between general practitioners and nurses.
In addition to publications, seminars and symposiums have been held on the subject.

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EHPG 2019

As part of the international EHPG European Health Policy Group, in which Zeynep Or, researcher at IRDES, participates as a member of the scientific committee, a meeting is being held on 11 and 12 April 2019 in Bologna (Italy). This multidisciplinary, collegial and informal network aims to foster international collaboration and knowledge exchange on European health systems through biannual meetings bringing together renowned researchers and students.

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EPH Conference - European Public Health Association (EUPHA)

IRDES is one of the local partners of the 12th Conference of the European Public Health Association (EUPHA), which this year's theme is "Building Bridges for Solidarity and Public Health". The Conference will be held in Marseille (France) from 20 to 23 November 2019. The call for papers is open until 1 May 2019.

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 Registrations

5th IRDES-DAUPHINE Workshop on Applied Health Economics and Policy Evaluation

The 5th IRDES-DAUPHINE Workshop on Applied Health Economics and Policy Evaluation will take place in Paris, France, on 20-21 June 2019. The workshop is organized by IRDES in collaboration with Chaire Santé Dauphine (Paris-Dauphine University).

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Persons with Severe Mental Disorders: Life Expectancy Is Greatly Reduced and Premature Mortality Has Quadrupled

Coldefy M., Gandré C. (IRDES)
Issues in Health Economics (237). September 2018

The mortality of individuals with severe mental disorders had only ever been studied in a fragmentary way in France. The availability of data relating to the medical causes of death linked with healthcare consumption data in the National Health Data System (Système National des Données de Santé, or SNDS) has enabled the study of such mortality on a national scale among the main beneficiaries of the French National Health Insurance (NHI).
The reduction in life expectancy for individuals with mental disorders is on average 16 years for men and 13 years for women, with variations in this figure depending on the disorders. These individuals have a mortality rate that is two to five times higher than those of the general population, whatever the cause of death, and a quadruple incidence of premature mortality. These initial findings could be complemented by studies focused on explaining this excess mortality. Concurrently, our results support the implementation of targeted initiatives to reduce the health inequalities experienced by persons with a mental disorder.

96% of Employees had Access to Employer-provided Complementary Health Insurance in 2017

Lapinte A. (DREES), Perronnin M. (IRDES)

Issues in Health Economics (236). July-August 2018

The National Inter-Professional Agreement (Accord National Interprofessionnel, ANI) of 11 January 2013 extended employer-provided complementary health insurance to all private-law employers and established minimum levels of coverage, and required employers to pay a minimum of 50% of the premiums of their workers. Establishments had to comply with this obligation before 1 January 2016.
According to the Employer-provided Complementary Health Insurance Survey (PSCE), more than one establishment in two instituted health insurance coverage or modified existing coverage due to the National Inter-Professional Agreement (ANI). As a result, 84% of establishments, employing 96% of employees, provided complementary health insurance in 2017, compared with half of establishments before the National Inter-Professional Agreement (ANI).
Establishments that remain without health insurance are very often small companies in which all the employees have expressed a preference to have a health coverage exemption. Establishments that had recently taken out health insurance for their employees were increasingly using insurance companies. When sectors of activity recommended an insurer, more than half of the establishments concerned followed the recommendations. Lastly, employers' financial contributions remained stable compared with 2009, the year in which the preceding edition of the Employer-provided Complementary Health Insurance Survey (PSCE) was conducted.

Impact Evaluation of Pilots for improving "Healthcare Pathways of Seniors" (PAERPA). Initial findings

Or Z., Bricard D., Le Guen N., Penneau A. (IRDES)

Issues in Health Economics (235). July-August 2018

Regional pilots, Healthcare pathways of seniors (PAERPA) launched in 2014 in nine territories (local areas) with the objective of improving care coordination and quality of life of frail elderly people aged 75 and over and their families, with a better organisation and coordination of professionals working in the health, social, and medico-social sectors at the local level.
The impact evaluation of pilot projects, carried out by IRDES, had to tackle many methodological issues due to the number and diversity of the actors involved in pilots, the variety of interventions implemented in each territory, and the heterogeneity of the territories selected on a voluntary basis.
The initial findings, based on data from 2015 and 2016, first years of implementation of the pilot projects, do not indicate a significant average effect of PAERPA on the outcome indicators studied when all the territories are treated together. However, the evaluation by territory did point to significant improvement linked to PAERPA in some regions for some outcome indicators sensitive to primary care coordination.

The Health Care Pathway of Stroke Patients: Contribution of Administrative Medical Databases in Identifying Risk Factors and Determining the Case-Severity during an Initial Episode in Acute Phase

IN FRENCH

Léandre C. (IRDES; AP-HP) and Com-Ruelle L. (IRDES). In collaboration with Bricard D., Le Guen N., Le Neindre C. et Nestrigue C. (IRDES)

IRDES Report (570). March 2019

Background: The study aims to identify the risk factors of patients hospitalized in acute-care hospitals for a first episode of stroke and to analyse differences between patients admitted to intensive care during their hospitalization and others.
Methods: Patients were identified in the 2012 National Health Data System (SNDS) with main diagnosis stroke (ICD-10 codes: I60-I64). Patients with transient ischemic attack (TIA) over the past 2 years are excluded from the analysis. Risk factors were identified in the two years before hospitalization through specific treatments for risk factors and/or specific long term diseases linked to risk factors and/or hospitalization with risk factors specific diagnosis codes. A logistic regression was realized to explain the probability of receiving intensive care.
Results: 98 853 patients were concerned: 67% had an ischaemic stroke, 20% a haemorrhagic stroke, 5% a sub-arachnoid haemorrhage, 7% no aetiology identified. Risk factors were: high blood pressure which concerned 51% patients, hyperlipidaemia 37%, diabetes 20%, depression 20%, atrial fibrillation 16%, chronic kidney failure 13%, smoking habit 12%, obesity 3,6% and alcoholism 3,1%. Major exogenous variables provoking intensive care were haemorrhagic stroke (OR: 3.5; p < 0.001), sub-arachnoid haemorrhage (OR: 11; p < 0.001) and to suffer from two or more life-threatening conditions (OR: 75; p < 0.001).
Conclusion: The SNDS allows analysing risk factors of stroke, although some can only be approached indirectly. Admission to intensive care is mainly conditioned by the acute health status.

Evolution of Expenditure in Terms of Complementary Health Insurance of CMU-C Beneficiaries: Analysis and Forecasting

IN FRENCH

Carré B., Perronnin M. (Irdes). Co-publication IRDES/ Fonds CMU-C

IRDES Report (569). November 2018

Introduced on 1 January 2000, the Complementary Universal Health Insurance (CMU-C) is a free health insurance scheme, accessible on a means-tested basis. It aims to remove financial barriers to access to health care for the poorest, such as advance payments and out-of-pocket payments left by the compulsory National health insurance. The number of CMU-C beneficiaries, stable between 2000 and 2009, then increased sharply, from 4.15 million in 2009 to 5.3 million in 2015 and 5.6 million on 31 July 2018, due to the economic turmoil and the increase in 2013 of the resource thresholds qualifying for the scheme. However, the average costs per beneficiary associated with reimbursements of the CMU-C scheme, which increased until 2012, are then decreasing steadily. How can this evolution be explained?
This study aims to understand and predict the dynamics of the evolution of CMU-C reimbursements. Based on a literature review that emphasizes the specificities and determinants of health expenditure of CMU-C beneficiaries, different hypotheses are tested on the causes of disruption in the evolution of this expenditure based on microeconomic data: the National Health Data System (SNDS, Système national des données de santé) of individuals belonging to the main sample of the Health, Health Care and Insurance Survey (ESPS, Enquête santé et protection sociale) and the Generalist Sample of Beneficiaries (EGB, Échantillon généraliste de bénéficiaires). The results show that the differences in the evolution of the composition of CMU-C beneficiaries - arrival after 2013 of beneficiaries with lower use of health care services - and that of the general population - whose ageing is more pronounced - are the two explanatory factors of the growing gap between these two populations. Finally, a forecasting model is estimated, based on macroeconomic data.

Health Care Accessibility and Spatial Attractiveness: Proposal for a Taxonomy of French Living Territories

IN FRENCH

Chevillard G., Mousquès J. (IRDES)

IRDES Working paper (76). January 2019

We present here the methodology and the results of a socio-sanitary taxonomy of French territories. This taxonomy is used to analyze primary health care in France and the effectiveness of measures to attract and retain general practitioners in underserved areas. We identify in the literature the relevant dimensions and indicators to address these issues. We made a Principal Component Analysis (PCA) of the 32 selected indicators and then an Agglomerative Hierarchical Clustering (AHC). We obtain six types of living territories which spatial distribution could be very contiguous (littoral, "empty diagonal"), more heterogeneous with departments having all types of living territories or a distribution showing opposition between centers and peripheries.

Has the Diffusion of Primary Care Teams in France Improved Attraction and Retention of General Practitioners in Rural Areas?

Chevillard G., Mousquès J., Lucas-Gabrielli V., Rican S., Health Policy, Online: 08/03/2019.
(Catégorie 2 - CNRS) - (Cat. A - Hcérès)

Smoking among Immigrant Groups in the United States: Prevalence, Education Gradients, and Male-to-Female Ratios

Pampel F., Khlat M., Bricard D., Legleye S. Nicotine & Tobacco Research, Online: 13/02/2019, 1-28.

Long-Term Effect of Outdoor Air Pollution on Mortality and Morbidity: A 12-Year Follow-up Study for Metropolitan France

Sanya S., Rochereau T., Maesano C.N., Com-Ruelle L., Annesi-Maesano I., International Journal of Environmental Research and Public Health, vol 15, n° 11, 2018/11, 1-8.

The Patient-reported Experience Measure for Improving Quality of Care in Mental Health (PREMIUM) Project in France: Study Protocol for the Development and Implementation Strategy

Fernandes S., Fond G., Zendjidjian X., Michel P., Baumstarck K., Lancon C., Berna F., Schurhoff F., Aouizerate B., Henry C., Etain B., Samalin L., Leboyer M., Llorca P.-M., Coldefy M., Auquier P., Boyer L. Patient Preference and Adherence, vol 13, 2019/01, 165–177.

Impact of Early Primary Care Follow-up after Discharge on Hospital Readmissions

Bricard D., Or Z., The European Journal of Health Economics, On line: 02/01/2019, 1-13.

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... Magali Coldefy and Coralie Gandré, following the publication of Issues in Health Economics (237), September 2018: "Persons with Severe Mental Disorders: Life expectancy is Greatly Reduced and Premature Mortality has Quadrupled".

• What is the type of health inequalities experienced by people with mental disorders?
• How do you explain this?
• How do you plan to develop these initial findings?

Read the interview