Identifying Wheelchair Users in France and Calculating their Patient Contribution based on Data from the National Health Data System (SNDS) between 2012 and 2019

Espagnacq M., Daniel F., Regaert C. (IRDES)

Questions d'économie de la santé (Issues in Health Economics) n° 272 - October 2022

QES n° 272

The creation in 2021 of the fifth branch of the French Social Security system devoted to reduced autonomy and the debate over the need for a major law concerning its funding has highlighted the issues relating to improvements and knowledge in this sector. This study is part of a research programme (entitled FISH), whose goal - based on administrative data (National Health Data System, SNDS) relating to the healthcare reimbursements made by the French National Health Insurance system (hereinafter Assurance Maladie) - is to improve knowledge about functional limitations in France. This initial study focuses on wheelchair users in order to assess their number and determine their profile (age and gender), and the type of wheelchair they purchased and its cost, by making a distinction between social security expenditure and patients' contributions.
Based on data from the SNDS, an algorithm was developed to estimate the number of persons regularly using a wheelchair in 2019. To do this, it was necessary to take into account all of the available information about the possession of wheelchairs (the rental or purchase of a wheelchair, accessories, pressure ulcer cushion, maintenance packages, etc.), to identify occasional use and the data was applied over a period of several years (2012-2019). Hence, only 50% of wheelchair users were located by a direct identification of the wheelchair (purchase or rental). The others may have bought their wheelchair before 2012, obtained it in the care home they resided in, or as a gift, loan, or second-hand purchase. In 2019, there were more than one million non-temporary wheelchair users, mostly women over the age of seventy.
Between 2012 and 2019, the National Health Insurance System had a global expenditure of one billion euros. Over the period, the costs of one out of two users were fully reimbursed by the National Health Insurance System, but after reimbursement almost 60,000 people had out-of-pocket healthcare costs amounting to more than 1,000 euros. On average, these out-of-pocket costs were 5,500 euros.

See also Questions d'économie de la santé n° 272 in French: Repérer les usagers de fauteuils roulants en France et calculer leur reste à charge à partir des données du Système national des données de santé (SNDS) de 2012 à 2019.