November 2023


3 questions to…

… Coralie Gandré, Delphine Moreau, Ibtissem Ben Dridi and Anna-Veera Seppänen, following the publication of the Issues in Health Economics (281), September 2023: "Barriers, Levers, and Contrasts in Complex Care Pathways: the Case of Cancer amongst People Living with a Severe Mental Illness", written in collaboration with the Canopée Consortium

1. Why did you base your study of the somatic care pathways of people living with a severe mental illness on the example of cancer care?
2. Which inequalities have you observed that are specific to this population?
3. What health care adaptations would be essential to improve their care?    
 Read the interview


Indicators of the quality of breast cancer care pathways for women with or without severe mental illness


IRDES publishing

Barriers, Levers, and Contrasts in Complex Care Pathways: the Case of Cancer amongst People Living with a Severe Mental Illness

Pichetti S. (IRDES), Espagnacq M. (IRDES)
Gandré C. (IRDES, Hôpital universitaire Robert Debré), Moreau D. (EHESP), Ben Dridi I. (EHESP) and Seppänen A.-V. (IRDES), in collaboration with the consortium Canopée
Issues in Health Economics (Questions d'économie de la santé), n° 281. September 2023

The excess mortality of people living with a mental illness has been recognised as a public health issue for a decade in France. However, concrete initiatives to address it are still limited and require a better understanding of the complex somatic care pathways of this population, who presents multiple vulnerabilities. Leveraging an analysis of cancer care pathways - based on a dual qualitative and quantitative approach -, this research highlights disparities for people living with a severe mental illness, relating in particular to the receipt of recommended diagnostic tests, timeliness between diagnosis and treatments, post-treatment follow-up, and risk of death, while underlining the heterogeneity of the situations experienced. The differences identified in the care pathways could be linked with adaptations to the specific circumstances of individuals and their choices, but also with preconceptions about the difficulties associated with mental illness and inadequate care organization, which could be improved by dedicated public policies.
 Read more

The Non-Coverage of Complementary Health Insurance in France in 2019 Initial Findings of the European Health Interview Survey (EHIS)

Pierre A. (IRDES), in collaboration with Rochereau T. (IRDES)
Issues in Health Economics (Questions d'économie de la santé), n° 268. May 2022

Although the number of individuals without complementary health insurance is at its lowest level -having dropped from almost 14% of the population aged 15 years and over in 1996 to 3.6% in 2019-, the current organisation of complementary health insurance and recent reforms aimed at employed individuals leaves part of the population by the wayside. Hence, the segment of the population that does not have an employer complementary health insurance policy and does not benefit from the Complementary Health Solidarity (CSS, Complémentaire Santé Solidaire) has to pay the high premiums of individual policies, in particular the elderly. We describe the 2.5 million French persons without complementary health insurance in 2019, based on the findings of the 2019 European Health Interview Survey (EHIS).
 Read more

Do Primary Care Teams Attract Young GPs to Medically Underserved Areas?

Chevillard G., Mousquès J. (IRDES)
Issues in Health Economics (Questions d'économie de la santé), n° 247. March 2020

Geographical accessibility to general practitioners (GPs) is decreasing and territorial inequalities are increasing. The areas in which accessibility is decreasing the most are also those that are the furthest away from employment centres, facilities, and services. The location of GPs is therefore part of a more general territorial problem. In view of the importance of health issues for the population, it is also a key element of France's spatial planning policy. In this context, this study assesses the impact of Primary Care Teams (PCTs, Maisons de santé pluriprofessionnelles) on the evolution of the density of GPs by distinguishing the effects according to the areas and doctors' age groups. In areas with poor accessibility to healthcare services, does the opening of PCTs encourage new GPs to establish and remain in practices over the long term? Does the opening of PCTs consolidate and maintain GP services? (…)
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Is the Public-Private Mix in French Health System Sustainable?

Pierre A., Or Z. (IRDES)
IRDES Working Papers (Document de travail de l’Irdes), n° 91. Juillet 2023

France is known for having one of the best health care systems in the world. Indeed, its responsiveness is rated high; patients have a large choice of public and private providers without chronic waiting time problems observed in some OECD countries. Out-of-pocket payments are among the lowest in OECD area and the health status of the population ranks amongst the best in the world. However, promoting a universal health system built on a mix of public and private funding and provision raises numerous challenges to ensure equity and efficiency in the system. In this Working Paper, we present the unique public/private mix of healthcare funding and delivery in France and discuss to what extent this mix contributes to achieving overall health system goals of better health outcomes, equity and efficiency. (…)
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Consequences of Multiple Sclerosis on Career Pathways in France EMOJI Study (Effects of Multiple Sclerosis on Occupational TraJectorIes)

Leray E. (EHESP, INSERM U1309 RSMS), Espagnacq M. (IRDES), Duguet E. (Université Paris-Est Créteil), Guillaume S. (IRDES), Guilleux A. (EHESP), Pichetti S. (IRDES), Regaert C. (IRDES)
Irdes Reports (Rapports de l’Irdes), n° 589. September 2023

A chronic degenerative disease of the central nervous system, Multiple sclerosis (MS) affects around 120,000 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. This study focuses on measuring the effects of MS on career pathways, in the short and medium term, over a period of one to twenty years. It then focuses on the MS population who go on disability, observing their situation before and after this transition in order to determine the ôle nts favourable or not to good financial conditions for going on disability.
The results highlight the significant, negative and lasting effects of the onset of MS on the career pathway. They also underline that income replacement has enabled people covered by the long-term illness (Affection de Longue Durée, ALD) scheme to maintain their level of financial resources to some extent. However, their situation over time (ten years), compared with the rest of the population, deteriorated sharply (…) The qualitative analysis highlights the importance of the rôle played by the spouse and provident schemes in reducing this downgrading.
 Read more

An Analysis of the Deployment of Advanced Practice Nurses in Primary Care in the Ile-de-France Region

Irdes Reports (Rapports de l’Irdes), n° 588. July 2023

Against a backdrop of government-backed reorganization of the healthcare system to address medical desertification, this report presents the results of the qualitative sociological survey Advanced Practice Nurses (IPA) in Primary Care (IPASOP). This new profession, IPA, included as part of the French Healthcare System Modernization Law in January 2016, saw its application texts published in 2018. The role of the IPA is seen as one of the essential levers in the new organization of work to deal with medical deserts, by relieving doctors of certain tasks and participating in, or even organizing, care pathways.
The main aim of this study was to document the implementation of IPAs in primary care, and more specifically in Multiprofessional Group Practices (Maisons de santé pluriprofessionnelles, MSPs). The aim of the survey was to assess the effects of the introduction of IPAs in MSPs on relations between healthcare professionals, and the recomposition of boundaries between professional groups: doctors, but also other paramedical professions practicing in MSPs (self-employed nurses, dieticians, etc.), and even professionals practicing in other care sectors (hospital, private structures, medico-social facilities).
 Read more

Other IRDES researcher's publications (in English)

Direct and Indirect Impact of the COVID-19 Pandemic on the Survival of Kidney Transplant Recipients: A National Observational Study in France.
Leye E., Delory T., El Karoui K., Espagnacq M., Khlat M., Le Cœur S., Lapidus N., Hejblum G., on behalf of the COVID-HOSP Working Group. American Journal of Transplantation. En ligne : 26 octobre 2023.

Association Between Pain and Mental Health Among Undocumented Immigrants in France.
Moussaoui S., Vignier N., Guillaume S., Jusot F., Marsaudon A., Wittwer J., Dourgnon P.
Research Square. Preprint (Version 1). 13/09/2023, p. 1-14.

Special Issue: On the Roof Top of Health Policy Change: Overlooking 21 Years of the European Health Policy Group.
Wallenburg I., Friebel R., Henschke C., Kristensen S.R., Nicińska A., Or Z. Health Economics, Policy and Law, en ligne le 13/09/2023, p. 1-3.
(Catégorie 3 - CNRS) - (Cat. B - Hcérès)

Challenges Facing Mental Health Systems Arising from the COVID-19 Pandemic: Evidence from 14 European and North American Countries.
Cummings J.R., Zhang X., Gandré C., Morsella A., Shields-Zeeman L., Winkelmann J., Allin S., Augusto G.F., Cascini F., Cserháti Z., de Belvis A.G., Eriksen A., Fronteira I., Jamieson M., Murauskienė L., Palmer W.L., Ricciardi W., Samuel H., Scintee S.G., Taube M., Vrangbæk K., van Ginneken E. Health Policy. En ligne 12/07/2023.
(Catégorie 2 - CNRS) - (Cat. A - Hcérès)

Cross-Country Performance in Social Integration of Older Migrants: A European Perspective.
Berchet C., Sirven N., Document de travail n° 8. Paris : Legos, 2023/05, 25 p.

Economic Layoffs and Mental Health : Evidence from French register-survey data.
Le Clainche C., Lengagne P. Revue d'Économie Politique, vol. 133, n° 3, 2023/05-06, p. 367-407.
(Catégorie 2 - CNRS) - (Cat. A - Hcérès)

Health Systems in Transition: France. Health System Review 2023.
Or Z., Gandré C., Seppänen A.-V., Hernández-Quevedo C., Webb E., Michel M., Chevreul K. European Observatory on Health Systems and Policies ; WHO Regional Office for Europe, vol. 25, n° 3, 2023/07, 276 p.

General Practitioners Activity Patterns: The Medium-Term Impacts of Primary Care Teams in France.
Cassou M., Mousquès J., Franc C., Health Policy, en ligne 02/07/2023.
(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.

- November 2023

- October 2023

- September 2023

- July-August 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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