Irdes Newsletter n° 12 - April 2018
Europe - A la une, extérieur
Every quarter, find the latest health economics news at IRDES: publications, seminars, interviews, detailed figures and documentation tools.
See previous letters
Every month find the French Newsletter
Conferences and Seminars
Consult the calendar of conferences classified by date and place.
Rencontres de géographie de la santé (Health Geography Meetings)
IRDES is participating in the organising committee for the first Health Geography Meetings, which will take place on 14 and 15 June 2018 in Lyon (France). They are organized in two stages: a forum for young researchers whose work links geography and health; presentations/discussions around two themes: the teaching of health geography and research/action projects under construction on territory and health.
4th IRDES-DAUPHINE Workshop on Applied Health Economics and Policy Evaluation
The 4th IRDES-DAUPHINE Workshop on Applied Health Economics and Policy Evaluation will take place in Paris, France on June 21st-22nd, 2018. The workshop is organized by IRDES, with the Chaire Santé Dauphine.
The workshop will cover the following topics, with an emphasis on Public Policies analysis and evaluation: Social Health inequalities, health services utilization insurance, Health services delivery and organization, Econometric methodology.
Frailty of Elderly People and the Consumption of Medications: Inappropriate Polypharmacy and Prescriptions
Herr M., Sirven N., Grondin H., Pichetti S., Sermet C.
Issues in Health Economics (230), February 2018
Ageing is not a homogenous process. Some people are more frail than others: they are less able to deal with stressful events because their physiological reserves are insufficient (impaired nutrition, loss of muscular mass, etc.) and undergo negative consequences in terms of health and healthcare (hospitalisation, institutionalisation, death, etc.). For a number of years the French National Health Authority (Haute Autorité de Santé, HAS) has focused on the detection and treatment of frailty, in order to improve healthcare for the elderly. The proposed initiatives include the adjustment and simplification of the patients'medicinal treatments.
The originality of this study lies in its analysis of the relation between the use of medications and frailty, by taking into account both the quantity and the quality of the medications prescribed for elderly people aged 65 years or over. The study was carried out based on the data provided by the Health, Health Care and Insurance Survey (Enquête Santé et Protection Sociale, ESPS), conducted by the Institute for Research and Information in Health Economics (Institut de Recherche et Documentation en Économie de la Santé, IRDES) in 2012, merged with healthcare claims data from the French National Health Insurance system (Assurance Maladie), which provides a record of health care consumption. It suggests that polypharmacy and the use of certain potentially inappropriate medications - anticholinergic medications - are associated with frailty in elderly people.
Complementary Health Insurance in 2014: 5% Had no Cover and 12% of the Poorest 20% of Households Had no Cover
Perronnin M., with the collaboration of Louvel A.
Issues in Health Economics (229), January 2018
In 2012 and 2014, nearly 5% of the French population had no complementary health insurance cover. Despite the existence of assistance schemes for the poorest, the absence of complementary health insurance was often linked to income, and was more common among the unemployed, non-working people of working age, and young adults.
Nearly seven out of ten private-sector employees had employer-based complementary health insurance. Certain categories of employee - employees with fixed-term contracts (Contrat à Durée Determinée, or CDD), commercial employees, and unskilled workers - were much less likely to be covered by employer-based insurance. The vast majority of the self-employed, civil servants, and pensioners, a high proportion of whom had health insurance cover, had individual insurance policies and reported that they were less likely to have sufficient healthcare cover than private-sector employees who had group health insurance cover.
Does an Early Primary Care Follow-up after Discharge Reduce Readmissions for Heart Failure Patients?
Bricard D., Or Z. (IRDES)
Working paper (73), March 2018
Better monitoring of patients in primary care setting is often considered to be a solution for reducing avoidable hospitalisations and readmissions. In this paper, we test the hypothesis that the risk of readmission is associated with the timing and intensity of primary care follow-up, with a focus on consultations with a generalist (GP) after discharge by patients hospitalized for heart failure in France. We propose a discrete-time model which takes into account that primary care treatments have a lagged and cumulative effect on readmission risk measured on a weekly basis, using an instrumental variable strategy (IV).
The results from IV regressions suggest that a consultation with a GP in the first weeks after discharge can reduce the readmission risk by almost 50%, and that patients with higher ambulatory care utilisation have smaller odds of readmission. Furthermore, geographical disparities in primary care affect directly primary care utilization and hence indirectly the readmission risk. These results suggest that interventions which strengthen communication between hospitals and generalists are elemental for reducing readmissions and improving system-wide cost efficiency. In order to encourage better care transition and to improve patient outcomes after discharge, financial incentives for hospitals should be aligned with the objective of avoiding repeated hospitalisations. However, the current hospital funding system in France, based on patient volumes, does not provide any incentive for investments to improve patient follow-up after discharge.
IRDES Researchers' publications in other venues
Is there a 'Pig Cycle' in the Labour Supply of Doctors? How Training and Immigration Policies Respond to Physician Shortages
Chojnicki X., Moullan Y. Social Science & Medicine, online 31/01/2018, vol 200, 2018/03, 227-237.
With the contribution of Coldefy M. et al. In : Mapping and Understanding Exclusion: Institutional, coercive and community-based services and practices across Europe. Turnpenny A., Petri G., Finn A., et al., Bruxelles : Mental Health Europe, 2018, 91-102.
Impact of Multimorbidity on Healthcare Professional Task Shifting Potential in Patients with Type 2 Diabetes in Primary Care: a French Cross-sectional Study
Supper I., Bourgueil Y., Ecochard R., Letrilliart L. BMJ Open, 2017/11, vol 7, n° 11, 1-11.
Consequences of Recent Anti-immigration Policy
Dourgnon P., Das P. Jama Internal Medicine, vol 177, 2017/10, 1535.
3 questions to...
... Marie Herr, on the occasion of the publication of Issues in Health Economics (230), February 2018: Frailty of Elderly People and the Consumption of Medications: Inappropriate Polypharmacy and Prescriptions, written with Nicolas Sirven, Hélène Grondin, Sylvain Pichetti and Catherine Sermet
- What criteria do you use to define frailty and consumption of medications?
- What are the links between consumption of medications and frailty?
- What are the strengths and limitations of this study?
Read the interview
... Marc Perronnin, on the occasion of the publication of Issues in Health Economics (229), February 2018: Complementary Health Insurance in 2014: 5% Had no Cover and 12% of the Poorest 20% of Households Had no Cover, with the collaboration of Alexis Louvel
- What is the objective of your study?
- Which populations are the least covered by complementary health insurance?
- What effects can be expected from the widespread introduction of employer-based complementary health insurance?
Read the interview
Next Letter: June 2018