3 questions to… Jonas Poucineau, Damien Bricard and Paul Dourgnon, following the publication of the Issues in Health Economics (259), June 2021: "Expectable Effects on Poverty Reduction of the Health System Reforms Introduced in the National Strategy for the Prevention and Reduction of Poverty"
Our literature review is based on a work carried out for France Stratégie as part of the evaluation of the 2018 National Strategy for the Prevention and Reduction of Poverty. The strategy aims at reducing poverty and social and economic inequalities. The Strategy relies on five pillars: early childhood and education; support, training and employment; housing; social rights, and health. We are also considering three measures from the July 2020 so called "Ségur de la Santé"; this stakeholders' national consultation, although focused on health care supply with measures for investment in the health care delivery system, financing and organization of care, also had an objective of tackling social health inequalities. These measures concern access to and coverage of complementary health insurance, with the the "Complémentaire Santé Solidaire" (C2S) and the "100% Santé" health insurance measure, as well as the provision of local health care and medical-social housing for people living in extreme poverty.
These measures firstly aim at reducing the financial insecurity caused by health care expenses, reducing barriers to health care and at improving the health of people living in poverty. On the one hand, the decrease of catastrophic out-of-pocket payments, i.e. very high in relation to the patient's income, can reduce the risk of falling or remaining in poverty due to health problems, especially for people without complementary health insurance. On the other hand, economic and social status have reciprocal causal relationships with health status, which are built up over the whole life cycle. In particular, health has a short- as well as a long-term effect on social status, influencing access to employment and professional careers, but also the level of education. Better access to health care can thus, by improving their health, ultimately affect the social situation of the poor.
In France, the policies studied are part of a convergent process such as the programs aimed at facilitating access to health coverage for people living in poverty, and for which research studies had highlighted significant lower access to healthcare services. In the United States, the absence of universal health coverage has led to the development of programs to facilitate access to healthcare coverage for the poorest, which mechanisms, if not the magnitude of their effects, may shed light on the French case. We illustrate the provision of local health care using the examples of community and participatory health centers in the United States and Canada. Finally, the measures relating to medical-social housing are derived in part from the Housing First model, developed in the United States and implemented in many developed countries in Europe and North America, as well as the Medical Respite program, also in the United States.