Discover our new website!

4th IRDES Workshop on Applied Health Economics and Policy Evaluation

The 4th IRDES Workshop on Applied Health Economics and Policy Evaluation will to take place in Paris, France on June 21st-22nd, 2018. The workshop is organized by IRDES, Institute for Research and Information in Health Economics, 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.

 DEADLINE for submitting papers: January 16th 2018. Decisions will be made by March 5th.

Reminder

Harkness Fellowship

The Commonwealth Fund 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: 13 November 2017

 More information on the Commonwealth website

Variations in Surgical Practices in Breast Cancer Treatment in France

Or Z. (IRDES), Mobillion V. (Upec, IRDES), Touré M. (IRDES), Mazouni C. (Gustave Roussy), Bonastre J. (Gustave Roussy, INSERM-CESP)

Issues in Health Economics (226), March 2017

In 2015, breast cancer was the most common form of cancer suffered by women in France in terms of incidence (54,000 new cases) and mortality (12,000 deaths) [Inca, 2015]. The surgical treatment of breast cancers has improved due to developments in diagnoses and therapies, as well as the reconfiguration of cancer care provision. 
Conservative surgery (tumorectomy) became the principal treatment in more than 70% of the cases in the vast majority of hospitals in 2012. Between 2005 and 2012, the sentinel lymph node biopsy technique was offered in most of the healthcare facilities, and the number of patients who underwent this treatment tripled over the period. However, immediate breast reconstruction (IBR) after a total or radical mastectomy was still relatively rare, despite an increase in the number of instances where this technique was used. 
The implementation of these practices varied between hospitals and départements. These variations may partly be linked to patients' health status and their preferences. But they also attest to differences in the organisation of services and the availability of technical platforms, as well as differences in medical practices between hospitals. All things being equal, the probability of benefitting from the sentinel lymph node technique or immediate breast reconstruction is greater in the Cancer Centres (Centres de Lutte Contre le Cancer, or CLCC), the Regional Teaching Hospitals (Centres Hospitaliers Régionaux, or CHR), and in hospitals with a high patient volume.

Public and Private Health Insurances: How do they Contribute to Social Solidarity?

Jusot F. (Paris-Dauphine University, PSL Research University, Leda-Legos and IRDES), Legal R. (DREES), Louvel A. (DREES), Pollak C. (DREES and Paris Dauphine University Leda-Legos), Shmuel A. (Hebrew University-Hadassah School of Public Health)

Issues in Health Economics (225), March 2017

A health insurance system ensures solidarity through organized transfers (income redistribution) between high and low income classes. 
The solidarity depends on the structure of healthcare consumption and health insurance contributions by income groups. The solidarity that underpins the French health insurance system is primarily based on the progressive funding of compulsory health insurance: higher income individuals contribute more than lower income individuals. But despite strong social inequalities in health, which imply more extensive healthcare needs among low-income individuals, the benefits are relatively homogeneous between different income groups. They therefore only marginally increase the solidarity of the health insurance system due to barriers in access to certain types of healthcare. 
Unlike compulsory public health insurance, complementary private health insurance and out-of-pocket health expenses imply very few transfers between income groups. The mixity of the French health insurance system is therefore also a limiting factor in its solidarity between income groups.

Accessing Cancer Care: Developments in Cancer Care from 2005 to 2012

Bonastre J. (INSERM, Institut Gustave Roussy), Mobillion V. (Upec, IRDES), Or Z. (IRDES), Touré M. (IRDES)

Issues in Health Economics (221), January 2017

With about 355,000 new cases per year, cancer care is a challenge both in medical and economic terms. Over the last ten years, cancer care went through extensive restructuring, on the one hand under the influence of activity-based funding (Tarification à l'Activité, T2A) as a mode of financing hospitals and, on the other hand, following the implementation of minimal activity thresholds, although it is not yet known what the impacts are in terms of cancer care redistribution, geographical access, and quality of care across the French territory. 
The developments in hospital cancer care between 2005 and 2012 are described here, focusing on surgical and chemotherapy facilities. The effects of the reconfiguration of cancer care are examined from the perspective of the evolution of distances of access and admission rates at the département level. 
Over the studied period, some one hundred facilities that used to perform cancer surgery but with a low level of activity volume have been closed down, while the number of cases per facility increased, notably in the state-owned sector. Despite this, the average distance travelled by patients receiving cancer surgery or chemotherapy did not change much, but variations in admission rates for both of these treatments persist across departments. 
One of the next Issues in Health Economics, devoted to breast cancer surgery, will provide an analysis of the territorial differences in medical practices, which question equality of access and care quality across départements.

European Health Interview Survey-Health, Health Care and Insurance Survey (EHIS-ESPS) 2014

Célant N., Rochereau T. (IRDES)

Report n°566, October 2017
IN FRENCH

Conducted by IRDES since 1988, The Health, Health Care and Insurance Survey (ESPS) is a multidisciplinary tool that explores the relationships between health status, access to health services, access to public and private insurance, and the economic and social status of the individuals surveyed. In 2014, in collaboration with the Directorate of Research, Studies, Evaluation and Statistics (DREES), the ESPS survey was the support for the European Health Interview Survey (EHIS) which, for France, became the only general survey on the subject representative of the general population. 2014 is the last wave of the ESPS field survey, which will collect health care consumption data and match it with the data from the National Health Insurance system until 2016. For the 2019 wave and beyond, scheduled every six years, the French version of EHIS will introduce, in addition to the European issues included in a Eurostat regulation, questions specific to France on complementary health coverage. 
In 2014, ESPS is representative of about 95% of the population living in ordinary households in France. According to the survey results, nearly one in three people aged 15 years and over report a fairly good, poor or very poor health status. Nearly 40% declare a chronic health problem and a quarter mentions a limitation in their daily activities. The most disadvantaged social groups report overall poorer health than others. Approximately 9% of women and 5% of men suffer from depressive symptoms, making France the eighth of the 26 countries for which these data are available. 
Regarding complementary health insurance, nearly 5% of people report that they do not have one. The lack of complementary health insurance mainly concerns the most precarious population, such as unemployed people and those with low incomes. Despite existing support mechanisms (Universal Complementary Health Insurance, or Couverture maladie universelle complémentaire (CMU-C) and Health Insurance Vouchers Scheme, or Aide au paiement d'une complémentaire santé (ACS)), the primary reason for non-subscription remains the excessive cost of contracts.

A Multilevel Analysis of the Determinants of Emergency Care Visits by the Elderly

Or Z., Penneau A. (IRDES)

Working Paper n°72, September 2017
IN FRENCH

Emergency departments (EDs) are essential for providing a rapid treatment for some health problems but they are also used as the entry point by those who do not have any other means of obtaining non-urgent health care. The steady increase in ED visits, especially amongst the elderly, is a source of pressure on hospitals and on healthcare systems. This study aims to establish the determinants of ED visits by the older adults, over 65 years old, in France. 
We use multilevel regressions to analyse the role of factors associated with individual demand (socioeconomic characteristics and health status) and with the organisation of healthcare provision at municipal and wider 'département' level. ED visits vary significantly by the health status and the economic level of municipalities. Controlling for demand factors, ED rates by the elderly are lower in areas where accessibility to primary care is high, measured as availability of primary care professionals, out-of-hours care and home visits by generalists in an area. Proximity (distance) and size of ED are drivers of ED use. 
High rates of ED visits calls into question the quality, efficiency and accessibility of health services provided in ambulatory settings. There is room for manoeuvre for reducing ED visits by optimizing the local provision of ambulatory care services. Moreover, investing in new forms of delivering primary care to improve accessibility and ensure the continuity and coordination of care can reduce the use of emergency services and improve the quality and efficiency of the health care system.

Strategies and Governance to Reduce Health Inequalities : Evidences from a Cross-European Survey

Barsanti S., Salmi L.-R., Bourgueil Y., Daponte A., Pinzal E., Ménival S., Global Health Research and Policy, 2 (18), 2017: 3-11.

... Zeynep Or on the occasion of the publication of Issues in Health Economics (226), March 2017: Variations in Surgical Practices in Breast Cancer Treatment in France, in collaboration with Mobillion V. (Upec, IRDES), Touré M. (IRDES), Mazouni C. (Gustave Roussy), Bonastre J. (Gustave Roussy, INSERM-CESP).

• What does the expression "variation in practices" mean? Why did you choose to study breast cancer surgery?
• How do you measure these variations, both territorial and between hospitals?
• What can we learn from these results?

 Read the interview