3 questions to…

… Coralie Gandré, Pierre Lecarpentier and Magali Coldefy, following the publication of the Issues in Health Economics (267), April 2022: "The Use of Electroconvulsive Therapy in France: Initial National Findings Underline Significant Disparities", in collaboration with Anis Ellini

1. What is electroconvulsive therapy (ECT) and how has its perception evolved over time?
2. Who are the people who receive ECT treatment in France? Are their characteristics consistent with national guidelines?
3. Why is the use of this therapy so disparate across the country?    
 Read the interview

Charts

Annual out-of-pocket payments of the of the beneficiaries of the Disabled Adult Allowance (AAH) without complementary health insurance, depending on whether or not they have a long-term illness (ALD) scheme

IRDES events, conferences and workshops

Harkness Fellowship

The Commonwealth Fund, in collaboration with IRDES, 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: 1 November 2023
 More information on the Commonwealth Fund website

IRDES publishing

The Healthcare Consumption Profiles and Complementary Health Insurance of the Beneficiaries of the Disabled Adult Allowance (AAH)

Pichetti S. (IRDES), Espagnacq M. (IRDES)
Issues in Health Economics (Questions d'économie de la santé), 271, September 2022

The Disabled Adult Allowance (Allocation aux adultes handicapés, AAH), a minimum social benefit that provides disabled persons over the age of twenty with an income of €956 per month, is paid to 1.2 million beneficiaries in France. Less insured than the French population (96%), 87% of these persons had complementary health insurance in 2018, but only 11% benefitted from the free Universal health insurance scheme (Couverture maladie universelle, CMU), and 13% from the Health Insurance Vouchers Scheme (Aide à la complémentaire santé, ACS).
Since 2019, the Complementary Health Solidarity (Complémentaire santé solidaire, CSS) scheme has replaced these schemes in order to increase the diffusion of public health insurance, and, given their resources, the beneficiaries of the Disabled Adult Allowance (AAH) are most often eligible to benefit from the CSS with a financial contribution. Yet, some beneficiaries of the Disabled Adult Allowance still do not benefit from this scheme. To identify the characteristics of those who do not benefit from this insurance, this study focused on the exhaustive population of the 35,000 beneficiaries of the AAH, who were on the scheme between 2014 and 2018 without ever having complementary health insurance. Although this population only amounts to 3% of all of the beneficiaries of the AAH, it has specific characteristics and is potentially exposed to the risk of high out-of-pocket payments. (…)
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Involuntary Care and Coercion for Patients in Psychiatric Facilities: A Reduction Target that Remains to Achieve

Coldefy M. (IRDES), Gandré C. (IRDES, Hôpital universitaire Robert-Debré), with the collaboration of Rallo S. (ARS Paca)
Issues in Health Economics (Questions d'économie de la santé), 269, June 2022

A reduction in the use of involuntary care, seclusion and restraint measures is one of the objectives of the Roadmap for ‘Mental Health and Psychiatry’, in force 10 years after the implementation of the law of 5 July 2011, which modified procedures for resorting to involuntary care in psychiatric facilities, and five years after the law on the modernisation of the French healthcare system, which outlined a political will to regulate and reduce the use of coercion in psychiatry. In this context, this article presents a study on the use of these measures and their evolution at the national level, based on data from the Medical Information Database for Psychiatry (Recueil d’informations médicalisé en Psychiatrie, Rim-P). (…)
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The Use of Electroconvulsive Therapy in France: Initial National Findings Underline Significant Disparities

Lecarpentier P. (EPS Barthélémy Durand, IRDES), Gandré C. (IRDES), Coldefy M. (IRDES), in collaboration with Ellini A. (ATIH)
Issues in Health Economics (Questions d'économie de la santé), 267, April 2022

Electroconvulsive therapy (ECT) consists of triggering an epileptic crisis under general anaesthesia. It is one of the recommended treatments for severe psychiatric disorders that are resistant to standard treatments, particularly pharmacological ones. This procedure is associated with negative representations in the public mind, its mechanisms of action remain little understood and the literature on the wide-scale use of ECT is scarce.
This study examined the use of ECT in mainland France in 2019 and identified the main factors associated with its variation, using hospital activity data from the French Agency for Information on Hospital Care (ATIH) (...) According to this data, ECT was used to treat 3,705 persons in France in 2019; it is therefore a highly specialised treatment that is rarely prescribed. (…)
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Supporting the Renewing of Public Policy on Healthcare at a Regional Level: Learning How to Break the Framework through National Pilot Programs under Article 51

Bourgeois I. (IRDES, Icone Médiation santé), Morize N. (IRDES, Centre for the Sociology of Organisations, a research unit of Sciences Po), Fournier C. (IRDES)
Issues in Health Economics (Questions d'économie de la santé), 262, October 2021

Statement 51 of the 2018 French Social Security Funding Act (Article 51, Loi de Financement de la Sécurité Sociale, LFSS) introduced a scheme that allows for pilot experiment that derogate from standard funding and organisational rules for health care delivery organisations. They make it possible to decompartmentalise care, which is traditionally based on funding that remunerates services performed by self-employed healthcare professionals. Three pilot programs aimed at finding alternatives to fee-for-service payments were thus initiated at the national level: a risk-adjusted capitation payment accorded to the characteristics of the patients concerned for ambulatory healthcare professionals practising in Primary Care Teams (Paiement en équipe de professionnels de santé en ville, PEPS), a five-year pilot programme with additional financial incentives combining advances payment and shared savings aiming to improve coordination between hospital and Primary Care Teams (Incitation à une prise en charge partagée, IPEP), and an episode-based bundled payment system (Paiement à l’épisode de soins, EDS). Since the first two pilot programs focus, in particular, on the remuneration of primary healthcare professionals, they were examined in this study. The circular of 13 April 2018 informed the French Regional Health Agencies (Agences Régionales de Santé, ARS) about the procedure for monitoring experimental projects. In the various regions, the initiation of the implementation of the PEPS and IPEP pilot programs took place from the first half of 2018 to the beginning of 2020. How did the regional actors, in particular the ARS, implement the new schemes, some of which were intended to be national schemes? (…)
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Renewing Public Policy on Healthcare: Experimenting with Healthcare Organisations under Article 51 Scheme

Morize N. (IRDES, Centre for the Sociology of Organisations, a research unit of Sciences Po), Bourgeois I. (IRDES, Icone Médiation santé), Fournier C. (IRDES)
Issues in Health Economics (Questions d'économie de la santé), 261, September 2021

Statement 51 of the 2018 Social Security Funding Act (Article 51, Loi de Financement de la Sécurité Sociale, LFSS) allows for pilot experiment that derogate from standard funding and organizational rules for health care delivery organisations. These include two five-year pilot programs, one with a risk-adjusted capitation payment accorded to the characteristics of the patients concerned for ambulatory healthcare professionals practising in Primary Care Teams (Paiement en équipe de professionnels de santé en ville, PEPS) and another one with additional financial incentives combining advanced payment and shared savings aiming to improve coordination between hospital and primary care teams (Incitation à une prise en charge partagée, IPEP). Both aim to change the way in which primary healthcare is funded in France; primary care has hitherto largely been provided by self-employed healthcare professionals who are mainly paid on a fee-for-service basis. However, to implement these developments at the local level, the executive teams of the pilot program in the Ministry of Health and the French National Health Insurance Fund (Caisse nationale de l'Assurance maladie, CNAM) have to coordinate two objectives: dealing with the issues faced by the health care professionals and executive teams of the program in the scheme in order to experiment together, while creating generalisable schemes that will benefit as many healthcare teams as possible and that are adapted to the constraints of the health system. How do the executive teams of the pilot program coordinate these two dimensions?
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Complementary Health Insurance Market, Inequalities and Preferences for Coverage: The Effects of the Employer-provided Complementary Health Insurance Mandate

Pierre A. (IRDES)
IRDES Working Papers (Documents de travail de l'Irdes), 89, October 2022
IN FRENCH

The employer-provided complementary health insurance mandate has been effective since 1st January 2016. (…) We propose to study the effects of the employer-provided CHI mandate by pursuing three goals: (i) studying the evolution of the CHI market regarding risk pooling, policy premiums, and levels of coverage; (ii) analyzing the evolution of inequalities in CHI; (iii) shedding light on the opinions and preferences of individuals with regard to their coverage status. We use the most current and exhaustive sources of data and information (survey data, medico-administrative data, studies already carried out, etc.).(…)
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Feasibility of Identifying people at Risk of Disability (FISH) Using Data from the French National Health Data Information System (SNDS)
General methodology and algorithm results for motor or organic limitations

Espagnacq M., Sermet C., Regaert C. (IRDES), in collaboration with Daniel F. (IRDES) et Podevin M. (Argo Santé)
IRDES Reports (Rapports de l'Irdes), 587, April 2023
IN FRENCH

This report documents the methodology used to create an indicator designed to identify people at risk of disability on the basis of their healthcare consumption: Feasibility of identifying people at risk of disability (FISH, Faisabilité d'identification des personnes à risque de handicap). It then compares the results of this indicator with other indicators of functional limitations available in different surveys. (...) Thus, this indicator makes it possible to study local differences in the risk of severe functional limitations, based on data not directly linked to recognition of disability or dependency.
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The Environmental Sustainability of Health Care Systems
A literature review on the environmental footprint of health care system and interventions aiming to reduce it: towards a framework for action for France

Seppänen A.-V., Or Z. (IRDES)
IRDES Reports (Rapports de l'Irdes), 586, April 2023

Global warming poses an increasing threat to health and health care systems. At the same time, health care systems have a significant effect on the environment and are major contributors to global warming. Nevertheless, the contribution of health care to global warming is largely overlooked in policy, and there is an urgent need to identify interventions that could reduce the environmental impact of health care systems and to develop strategies to improve their environmental sustainability. In this report we present the results from two complementary literature reviews: the first provides an overview of the environmental impact of the main health care sectors and sources of pollution, and the second - a scoping review - identifies a representative sample of interventions used in high-income countries to reduce the environmental footprint of health care, and their estimated impact. We pooled the results from two reviews to propose a holistic framework for action for improving the environmental sustainability of the health care system. (…)
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Other IRDES researcher's publications (in English)

Factors for Consideration When Setting Prices for Private Healthcare Providers Operating in Public Systems: A Comparison of France and Japan.
Honda A., Cartailler J., Cailhol J., Noda S., Or Z. Health Services Insights, vol 16, en ligne le 23/05/2023, 1-13.

How Does the Quality of Care for Type 2 Diabetic Patients Benefit from GPs Nurses' Teamwork? A Staggered Difference in Differences Design Based on a French Pilot Program.
Gilles de la Londe J., Afrite A., Mousquès J. International Journal of Health Economics and Management, 2023/04, 1-34.
(Catégorie 2 - CNRS) - (Cat. A - Hcérès)

Health Policy - The Best Evidence for Better Policies. Editorial.
Quentin W., Achstetter K., Barros P.P., Blankart C.R., Fattore G., Jeurissen P., Kwon S., Laba T., Or Z., Papanicolas I., Polin K., Shuftan N., Sutherland J., Vogt V., Vrangbaek K., Wendt C. Health Policy. Vol. 127, 2023/01, 1-4.
(Catégorie 2 - CNRS) - (Cat. A - Hcérès)

Breast Cancer Care Pathways for Women with Preexisting Severe Mental Disorders: Evidence of Disparities in France?
Seppänen A.-V., Daniel F., Houzard S., Le Bihan C., Coldefy M., Gandré C. Journal of Clinical Medicine, vol.12, n° 2, 2023/01, 1-18.

European Immigrant Health Policies, Immigrants' Health, and Immigrants' Access to Healthcare.
Dourgnon P., Pourat N., Rocco L. Health Policy. En ligne le 23/12/2022.
(Catégorie 2 - CNRS) - (Cat. A - Hcérès)

Why the US Spends More Treating High-Need High-Cost Patients: A Comparative Study of Pricing and Utilization of Care in Six High-Income Countries.
Lorenzoni L., Marino A., Or Z., Blankart C.R., Shatrov K., Wodchis W., Janlov N., Figueroa J.F., Bowden N., Bernal-Delgado E., Papanicolas I. Health Policy. 2022/12.
(Catégorie 2 - CNRS) - (Cat. A - Hcérès)

Watch on Health Economics Literature

Produced by the IRDES documentation centre, Watch on Health Economics Literature, a monthly publication, presents by theme the latest articles and reports in health economics: both peer-reviewed and grey literature.

- June 2023

- May 2023

- April 2023

- March 2023

- February 2023

- January 2023

English-French Glossary of Health Economics Terms

This new online edition of the English-French Glossary of terms, concepts and acronyms in health economics has been reviewed and expanded by the IRDES Publications and Documentation teams. In addition to terms from specialized Anglo-Saxon journals, this edition is based on the English translations of IRDES thematic syntheses, Issues in Health Economics, and on the keywords of the MeSH thesaurus (Medline). It also includes a thematic section that classifies the translated terms according to the disciplines involved (economics, sociology, geography, etc.). The translation of French Institutions on Public Health into English is now integrated into the part: Sigles - Institutions.

The Glossary is updated regularly.

Getting information on Public Health in France and in Europe

Health Address Book

Calendar of conferences and seminars