3 questions to…

… Paul Dourgnon (IRDES) and Antoine Marsaudon (IRDES), following the publication of the Issues in Health Economics (280): “Access to Healthcare Services and Usual Source of Care of Undocumented Immigrants when Covered by State Medical Aid”, written in collaboration with Florence Jusot and Jérôme Wittwer

1. What impact does the State Medical Aid scheme have on access to healthcare for undocumented immigrants?
2. Did you monitor a change in the use of specific healthcare services, especially Emergency Departments (ED)?
3. What are the main lessons to be learned from French and foreign experience with State Medical Aid or equivalent schemes abroad?    
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Chart

Access to healthcare services and length of coverage by State Medical Aid

IRDES publishing

Lessons from a Comparison of Ambulatory Care in France and Germany
Minery S., Or Z. (IRDES)
Issues in Health Economics (Questions d'économie de la santé), n° 290. June 2024

Germany is the cradle of social health insurance, as the first health insurance scheme was introduced by the German Chancellor Otto von Bismarck at the end of the nineteenth century. While France based its social security system on the German model, the healthcare systems developed differently in the two countries. Healthcare spending in Germany, followed by France, are currently the highest in the world after the United States. However, the composition of these expenditures varies between the two countries. Both in Germany and France, the ambulatory and hospital care sectors are distinctly separate in terms of their organisation, funding, and regulation. This analysis, drawn from a broader study that compares healthcare spending in Germany and France, focusses on the organisation of ambulatory care in the two countries. By comparing the principal mechanisms and policies that define and regulate the volumes and prices of ambulatory care, we identify possibilities for improving the management of healthcare spending in France.
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 See also the report in French

Use of Seclusion and Restraint in Hospitals Providing Psychiatric Care in France in 2022: An Unprecedented Overview of the Affected Population and of Practice Variations Across Facilities

Touitou-Burckard E., Gandré C., Coldefy M., in collaboration with Ellini A., Saetta S. and the consortium Plaid-Care
Issues in Health Economics (Questions d'économie de la santé) n° 286. February 2024

The use of seclusion and restraint during psychiatric inpatient care is intended as a last resort in response to a crisis and should only be implemented in exceptional circumstances, in accordance with clinical practice guidelines. In France, the reduction in the use of these measures, which is a high priority on the global political agenda, is one of the objectives of the national roadmap for mental health and psychiatry launched in 2018. This objective is supported by a recent dissuasive legislative framework. In this context, this study provides recent data on the use of seclusion and mechanical restraint in hospitals providing psychiatric care on a national scale in France. (…). In 2022, 76,000 individuals were involuntary admitted to inpatient care in hospitals providing psychiatric care. 37% of these people (n=28,000) were secluded at least once, and 11% (n=8,000) were mechanically restrained. The use of these measures exhibited considerable variability between hospitals, with some facilities never resorting to these practices.
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Insured Like any Others: An Analysis of the Ambulatory Healthcare Consumption of Undocumented Immigrants Covered by State Medical Aid

Petit S. (Bordeaux University), Wittwer J. (Bordeaux University), Dourgnon P. (IRDES), Jusot F. (Paris-Dauphine University, PSL, Leda-Legos, IRDES), Marsaudon A. (IRDES)
Issues in Health Economics (Questions d'économie de la santé) n° 284. December 2023

Undocumented immigrants living in France are not eligible to the otherwise universal public health insurance. The State Medical Aid (Aide Médicale de l’Etat, AME) is a public health insurance scheme dedicated to them. (…)
What impact does the State Medical Aid scheme has on access to healthcare? Previous studies based on the "Premiers Pas" survey have shown that the State Medical Aid scheme is associated with less non-take up of healthcare services, and more medical consultations in medical practices or healthcare centres, rather than in emergency services and NGOs medical facilities. The patterns of healthcare use of immigrants covered by State Medical Aid appear to resemble those of the rest of the population in France.
In this second study, we compare the ambulatory healthcare consumption of the immigrants covered by State Medical Aid with that of persons covered by the non-contributory Comple-mentary Health Solidarity (Complémentaire Santé Solidaire non contributive (CSS-NC) scheme. (…)
The results (…) show that the two populations have similar consumptions regarding most healthcare goods, except for dental and optical care, which are well covered by the CSS-NC, but poorly covered by State Medical Aid.
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Access to Healthcare Services and Usual Source of Care of Undocumented Immigrants when Covered by State Medical Aid

Marsaudon A. (IRDES), Jusot F. (Université Paris-Dauphine, PSL, Leda-Legos, IRDES), Wittwer J. (Université de Bordeaux) and Dourgnon P. (IRDES)
Issues in Health Economics (Questions d'économie de la santé), n° 280. July-August 2023

State Medical Aid (Aide Médicale de l'État, AME) is a public health insurance that entitles undocumented immigrants access to medical care, including access to GP and specialist services, free of premium and out-of-pocket payments. Does State Medical Aid actually improve access to and use of healthcare services of undocumented immigrants? In this Issues in Health Economics, based on data from the 2019 "Premiers Pas" survey, we analysed whether undocumented immigrants covered by State Medical Aid use healthcare services in a different way to those who are eligible but who are not covered, both in terms of access to healthcare services and usual source of care. (…)
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Advanced Practice Nursing (APN) in French Primary Care: The Difficult Implementation of a Fragile Profession

Luan L. and Fournier C. (IRDES) In collaboration with Afrite A. (IRDES)
Issues in Health Economics (Questions d'économie de la santé), n° 277. April 2023

After completing an additional two years of training, advanced practice nurses (APNs) acquire an expanded range of competencies, including clinical examination skills and prescribing additional examinations and medication. (…)
This qualitative sociological research, based on interviews, studied the practices of these primary healthcare professionals, in a context of considerable tension with regard to the redefinition of the division of care work between healthcare professionals, particularly in private practice. Despite the interest the first APNs expressed in their new role, they all spoke about major difficulties in developing their clinical activities, and had to supplement their work by implementing care coordination activities within multidisciplinary teams, or by continuing, in parallel with their APN work, to practise as general nurses. The study of the first nurses to qualify as APNs, including a few ones who succeeded in building up a substantial patient base, shed light on the components of their work, and made it possible to analyse the conditions for its development. (…)
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Functional Motor and Organic Limitations: Significant Disparities Between the French Départements

Espagnacq M., Sermet C., Regaert C. and Daniel F. (IRDES)
Issues in Health Economics (Questions d'économie de la santé), n° 276. March 2023

Functional motor and organic limitations are defined as a restriction in the ability of individuals to perform certain functions such as locomotion, prehension, flexibility, digestion, continence, and so on. The identification of people with severe functional motor or organic limitations presented in this article was conducted using the "Feasibility of the identification of disabled persons" (Faisabilité d'Identification des Personnes en Situation de Handicap, FISH) indicator, constructed from data from the National Health Data System (Système National des Données de Santé, SNDS). Obtained from an administrative source (…), this indicator uses data that is available continuously and over a long period, relating to the entire population, regardless of age or place of residence, thus making it possible to increase knowledge of the populations suffering from impaired personal autonomy. This study is also the first to offer a comparison between the départements - covering all age groups and places of residence - of the risk of disability following these types of limitations. (…)
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The Use of IPEP and PEPS Experimental Funding in Five Multiprofessional Group Practices (MSPs) Towards a redefinition of the professional boundaries in the division of care work

Morize N. (Sciences Po, Centre for the Sociology of Organisations, affiliated to IRDES), Schlegel V. (IRDES, Cresppa-CSU)
Issues in Health Economics (Questions d'économie de la santé), n° 275. February 2023

New collective remuneration methods, which were alternatives to fee-for-service remuneration, were implemented within Multiprofessional Group Practices (MSPs) as part of experiments under Article 51 of the 2018 Social Security Funding Act (Loi de Financement de la Sécurité Sociale, LFSS). Two national pilot programmes - one with additional performance-type payment to improve coordination between hospital and primary care (IPEP, Incitation à une prise en charge partagée), and another one with a lump sum payment scheme for primary care teams for GPs and nurses (PEPS, Paiement en équipe de professionnels de santé en ville) - aimed, in the former case, to reinforce the dynamics of coordination between the outpatient care and hospital sectors, and, in the latter case, between doctors and nurses working together as a team. By introducing new collective funding methods within MSPs, the pilot programmes could complement transformations in the organisation of primary healthcare.
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Job Retention Difficulties Following the Clinical Onset of Multiple Sclerosis: Salary Loss and the Role Played by Income Replacement Benefits in Compensating for the Associated Decrease in Income

Espagnacq M. (IRDES), Leray E. (EHESP), Regaert C. (IRDES), Guilleux A. (EHESP), Pichetti S. (IRDES), Guillaume S. (IRDES) and Duguet E. (UPEC)
Issues in Health Economics (Questions d'économie de la santé), n° 274. January 2023

A chronic degenerative disease of the central nervous system, multiple sclerosis (MS) affects around 100,000 adults in France, predominantly young women. Non-fatal in the short term, the average age of onset of MS is between the ages of 20 and 40, and results in job retention difficulties in the long term. (…)
Based on a representative sample of French employees, using professional career data from the beginning of their careers until 2015, we compared the professional development as well as the salaries and replacement income linked to the professional activity (unemployment benefit, sick pay, and disability pension) of persons with MS who were beneficiaries of the long-term illness (LTI) scheme with those of the rest of the working population. (…)
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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. and Regaert C. (IRDES)
Issues in Health Economics (Questions d'économie de la santé), n° 272. October 2022

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 (…) 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 (…)
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Can People Afford to Pay for Health Care? New Evidence on Financial Protection in France

Bricard D. (IRDES)
Report in collaboration with WHO/Europe. April 2024

This review is part of a series of country-based studies generating new evidence on financial protection - affordable access to health care - in health systems in Europe. Catastrophic health spending is lower in France than in many other European Union (‎EU)‎ countries, but unmet need for dental care is above the EU average and both outcomes are marked by significant income inequality. Catastrophic health spending is heavily concentrated in the poorest fifth of households and mainly driven by out-of-pocket payments for outpatient medicines, medical products and outpatient care. This is likely to reflect widespread, heavy and complex user charges (‎co-payments)‎ for publicly financed health care, including substantial balance billing for medical products and outpatient care. Complementary health insurance (‎CHI)‎ covering user charges covers around 95% of the population and improves financial protection for most people due to sustained Government efforts to secure free or subsidized access to CHI for people with very low incomes.
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Improving the Organization of Chronic Renal Failure care Evaluation of Territorial Experiments in Six French Regions

Augé E., Bricard D., Raynaud D. (IRDES), in collaboration with Bayat S. and Raffray M. (EHESP)
Irdes Reports (Rapports de l’Irdes), n° 591. May 2024
IN FRENCH

The aim of this study is to measure the impact of the Article 43 of the French Social Security Financing Act which sets up experiments on the care pathways of patients with chronic kidney disease, and to identify the organizational changes implemented. These experiments have enabled the funding of pilot projects to improve the care pathway and autonomy of chronic kidney failure patients in six French regions. (...)
The results show that pilot projects focusing on the preparation for renal replacement therapy and transplantation have reduced the proportion of dialysis initiated as an emergency and improved access to the transplant waiting list.
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Atlas of Medical Practice Variations. The Use of Eleven Common Surgical Procedures

Or Z. (IRDES), Cartailler J. (IRDES), Le Bail M. (HAS, IRDES)
IRDES Books, n° 9 série Atlas. February 2024
IN FRENCH

Following on the first French Atlas of Medical Practice Variations published in 2016, this second Atlas takes stock of the situation and tracks changes in the rates of eleven surgical procedures between 2014 and 2019. This Atlas also expands the framework for monitoring and evaluating variations in medical practice in France by proposing three new indicators of process and quality of care: ambulatory surgery rates, use of Enhanced Recovery After Surgery protocols, and 30-day hospital readmission rates.
The Atlas provides an objective illustration of the differences in surgical practices between the French départements and their evolution over a five-year period to question their causes and appropriateness. Its aim is to encourage healthcare professionals to compare and question their practices, and to accustom policy makers and users of the healthcare system to the concept of variation in medical practice. This is essential for improving not only the quality but also equity of care.
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Other IRDES researcher's publications (in English)

The double burden of severe mental illness and cancer: A population-based study on colorectal cancer care pathways from screening to end-of-life care.
Seppänen A.-V., Daniel F., Houzard S., Le Bihan C., Coldefy M., Gandré C. Epidemiology and Psychiatric Sciences, Vol. 33-n°27, 2024/05.

Comparing GPs According to Their Model of Practice: Are Multiprofessional Group Practices Associated With More Favourable Working Conditions?
Biais M., Cassou M., Franc C. The European Journal of Health Economics, on line 3/04/2024
(Catégorie 2 - CNRS) - (Cat. A - Hcérès)

Impact of Multiple Sclerosis on Employment and Income: Insights from a Random Sample Representative of Private Sector Employees in France using Longitudinal Administrative Data.
Leray E., Regaert C., Duguet E., Guillaume S., Pichetti S., Espagnacq M. Revue Neurologique, en ligne 2024/04, 12 p.

The Role of the Health Sector in Tackling Climate Change: A Narrative Review.
Or Z., Seppänen A.-V. Health Policy. Vol 143, n° 05053, 2024/03, 27 p.
(Catégorie 2 - CNRS) - (Cat. A - Hcérès)

A French Classification to Describe Medical Deserts: A Multi-Professional Approach Based on the First Contact with the Healthcare System.
Bonal M., Padilla C., Chevillard G., Lucas-Gabrielli V. International Journal of Health Geographics, Vol 23, n° 5, 2024/02, 13 p.

Impact of the COVID-19 Pandemic on COPD Patient Mortality : A Nationwide Study in France.
Poucineau J., Khlat M., Lapidus N., Espagnacq M., Chouaïd C., Delory T., Le Coeur S. International Journal of Public Health, en ligne le 01/02/2024, 1-10.

Barriers and Facilitators to the HPV Maccine. A Multicenter Qualitative Study of French General Practitioners.
Tron A., Schlegel V., Pinot J., Bruel S., Ecollan M., Le Bel J., Rossignol L., Gauchet A., Gagneux-Brunon A., Mueller J., Banaszuk AS., Thilly N., Gilberg S., Partouche H. Archives de la santé publique, n° 2, 2024/01, 1-10.

Adolescent Hazardous Drinking and Socioeconomic Status in France: Insights into the Alcohol Harm Paradox.
Legleye S., Khlat M., Aubin H.J., Bricard D. Journal of Adolescent Health, en ligne le 8 décembre 2023.

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 2024

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- February 2024

- January 2024

- December 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.

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