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Francis-Oliviero F, Constantinou P, Haneef R, Schwarzinger M, Gallay A, Rachas A, Alla F. The health state of France before COVID-19 pandemic between 1990 and 2019: an analysis of the Global Burden of Disease study 2019. THE LANCET REGIONAL HEALTH. EUROPE 2024; 39:100848. [PMID: 38803633 PMCID: PMC11129279 DOI: 10.1016/j.lanepe.2024.100848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 05/29/2024]
Abstract
Background France faces nowadays some major challenges regarding its health care system including medically underserved areas, social health inequalities, and hospital pressures. Various indicators and sources of data allow us to describe the health status of a population and, consequently, to assess the impact of these challenges. We assessed the burden of diseases before COVID-19 in France in 2019 and its evolution from 1990 to 2019, and compared it with Western European countries. Methods We used specific Global Burden of Diseases (GBD) metrics: socio-demographic index (SDI), life expectancy (LE), healthy life expectancy (HALE), years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) with their 95% uncertainty interval (95% UI). We compared French age-standardized metrics to those for other Western European Countries for both sexes and also between 1990 and 2019. We also described the specific causes of these different metrics. Findings We observed for life expectancy at birth in France a trend to an improvement over time from 77.2 (95% UI: 77.2-77.3) years in 1990 to 82.9 (82.7-83.1) in 2019, which represented the seventh highest life expectancy among 23 Western European countries. HALE at birth in France increased from 67.0 (64.0-69.7) to 71.5 (68.1-74.5), which represented the fourth highest HALE among 23 Western European countries. In France, the total number of DALY per 100.000 population tended to decrease from 25,192 (22,374-28,351) in 1990 to 18,782 (16,408-21,920) in 2019. As compared to other European countries, the burden due to cardiovascular diseases was lower. Neoplasms and cardio-vascular diseases were the two leading causes of YLLs. Mental and musculoskeletal disorders were the two leading causes of YLDs. Interpretation Overall, these results highlight a clear trend of improvement in the health status in France with certain differences between western European countries. The health policy makers need to devise interventional strategies to reduce the burden of diseases and injuries, with specific attention to causes such as cancers, cardiovascular diseases, mental health and musculoskeletal disorders. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
- Florence Francis-Oliviero
- Service d'information médicale, Bordeaux University Hospital, 33000 Bordeaux, France
- Inserm UMR 1219-Bordeaux Population Health, 33000 Bordeaux, France
- University of Bordeaux, 33000 Bordeaux, France
| | - Panayotis Constantinou
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, 75 986 Paris Cedex 20, France
| | - Romana Haneef
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, Saint-Maurice, France
| | - Michaël Schwarzinger
- Inserm UMR 1219-Bordeaux Population Health, 33000 Bordeaux, France
- Department of Methodology and Innovation in Prevention, Bordeaux University Hospital, 33000 Bordeaux, France
| | - Anne Gallay
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, Saint-Maurice, France
| | - Antoine Rachas
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, 75 986 Paris Cedex 20, France
| | - François Alla
- Inserm UMR 1219-Bordeaux Population Health, 33000 Bordeaux, France
- University of Bordeaux, 33000 Bordeaux, France
- Department of Methodology and Innovation in Prevention, Bordeaux University Hospital, 33000 Bordeaux, France
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Savova A, Manova M, Tachkov K, Petrova G. The role of insurance policies in the drug pricing landscape. Expert Rev Pharmacoecon Outcomes Res 2024; 24:189-202. [PMID: 38064353 DOI: 10.1080/14737167.2023.2292693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/05/2023] [Indexed: 01/27/2024]
Abstract
INTRODUCTION This overview paper aims at summarizing and analyzing the available literature on healthcare system organization and pricing policies of 11 European countries, comparing them to the Bulgarian pharmaceutical system. The countries were selected based on the reference basket for the pricing of pharmaceuticals in Bulgaria - Belgium, Greece, Spain, Italy, Latvia, Lithuania, Romania, Slovakia, Slovenia, and France. AREAS COVERED In the first part, we explore the health system models in the above-mentioned countries. In the second part we explore the pricing and reimbursement policies, and in the third part we analyze healthcare and pharmaceutical economic indicators, as well as life expectancy. The major focus of the review is the outpatient care. EXPERT OPINION In this work, we attempted to outline differences and similarities between the countries of interest. Despite the differences in their healthcare system organization, health and pharmaceutical expenditures constantly increased during the observed 2 decades. This increase in expenditures, however, has not had a significant impact on life-expectancy. Minor increases were observed - from 2 to 4 years total. No country had an expectancy above 85 years of age. It might be said that other factors are influencing the life expectancy to a greater extent.
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Affiliation(s)
- Alexandra Savova
- Faculty of Pharmacy, Medical University of Sofias, Sofia, Bulgaria
- National council of prices and reimbursement of medicines, Sofia, Bulgaria
| | - Manoela Manova
- Faculty of Pharmacy, Medical University of Sofias, Sofia, Bulgaria
- National council of prices and reimbursement of medicines, Sofia, Bulgaria
| | | | - Guenka Petrova
- Faculty of Pharmacy, Medical University of Sofias, Sofia, Bulgaria
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Ohannessian R, Yaghobian S, Simon R, Poinsot-Chaize G, Hiridjee S, Gleize JC, Pierme JP, Amar N, Merlaud C, Maudoux C, Zerah B, Lescure F, Salomon J. Evaluating the Impact of Teleconsultations on Access to Ambulatory Primary Care in Medically Underserved Areas: A National Observational Cross-Sectional Multicenter Study. Telemed J E Health 2024; 30:570-578. [PMID: 37643308 DOI: 10.1089/tmj.2023.0274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
Introduction: Access to care is a major public health concern particularly in medically underserved areas (MUAs) (Zones d'Interventions Prioritaires). Teleconsultations were legalized in France in 2010, however, have been reimbursed by the national health insurance since 2018. Large-scale studies assessing the impact of teleconsultations on access to care are limited. The objective of this study was to evaluate the impact of teleconsultations in MUAs at a national scale. Methods: An observational, multicenter cross-sectional study was conducted in seven teleconsultation centers. Teleconsultations were included if they were with patients living in France and received ambulatory care at primary ambulatory care settings by registered medical doctors between August 1 and November 30, 2021. Each center provided a randomized sample of 3,000 case data per month, yielding a total of 84,000 patients. Teleconsultation incidence was measured in MUAs and non-MUAs as the primary outcome. Results: In total, 25.1% of French patients lived in MUAs, with a mean age of 30.1 ± 0.08 years. Incidence of teleconsultations was 1,964 per 100,000 compared with 787 per 100,000 in non-MUAs (p < 0.0001). Teleconsultations were mostly performed during the day (88.6%), on weekdays (90.6%), were booked (88.3%), involved a general practitioner (GP) (89.0%), and were carried out as a video consultation (96.5%). The median delay to access was 60 min for GPs. Discussion: This was the largest study of teleconsultations in France and the first in the world to pool data from competing telemedicine companies. The incidence of teleconsultations was higher in MUAs, which may show that teleconsultations improve access to care. Clinical Trial Registration number: NCT05311241.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - François Lescure
- Teladoc, Paris, France
- Les Entreprises de Télémédecine, LET, Paris, France
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Douine M, Lambert Y, Plessis L, Jimeno I, Galindo M, Bardon T, Le Tourneau FM, Molinié P, Vié A, Adenis A, Nacher M, Figueira da Silva A, Vreden S, Suarez-Mutis MC, Sanna A. Social determinants of health among people working on informal gold mines in French Guiana: a multicentre cross-sectional survey. BMJ Glob Health 2023; 8:e012991. [PMID: 38103896 PMCID: PMC10729274 DOI: 10.1136/bmjgh-2023-012991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/25/2023] [Indexed: 12/19/2023] Open
Abstract
INTRODUCTION Social determinants of health, such as living and working conditions, economical and environmental context and access to care, combine to impact the health of individuals and communities. In French Guiana (FG), the persons working in informal artisanal and small-scale gold mining in the rainforest are a particularly vulnerable population which lives in precarious conditions and far from the health system. Previous studies have demonstrated their high morbidity due to infectious diseases. This study aims to describe the social determinants of health in this specific population. METHODS This international multicentre cross-sectional survey included people working on the informal FG gold mines at the crossing points located at both borders with Suriname and Brazil. After collecting written informed consent, a structured questionnaire was administered. RESULTS From September to December 2022, 539 gold miners were included. These poorly educated migrants, mainly from Brazil (99.1%) did not have access to drinkable water (95.4%), lived in close contact with wild fauna by hunting, eating bushmeat or being bitten and were exposed to mercury by inhalation (58.8%) or ingestion (80.5%). They report frequent accidents (13.5%) and chronic treatment interruptions (26.6% of the 11.9% reporting chronic treatment). Half of them considered themselves in good health (56.4%). CONCLUSION This study shows a singular combination of adverse exposures of gold miners working in FG such as zoonoses, heavy metal poisoning, aggression of wild fauna. For ethical as well as public health reasons, actions towards health equity must be considered at different levels: individual, community, environmental, systemic and global level. As end users of minerals, we must assume our responsibilities for the well-being of the extractors by including health in political decisions to engage together in global health. TRIAL REGISTRATION NUMBER NCT05540470.
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Affiliation(s)
- Maylis Douine
- Centre d'Investigation Clinique Antilles-Guyane, CIC Inserm 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Yann Lambert
- Centre d'Investigation Clinique Antilles-Guyane, CIC Inserm 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Lorraine Plessis
- Centre d'Investigation Clinique Antilles-Guyane, CIC Inserm 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Irène Jimeno
- Centre d'Investigation Clinique Antilles-Guyane, CIC Inserm 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Muriel Galindo
- Centre d'Investigation Clinique Antilles-Guyane, CIC Inserm 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Teddy Bardon
- Centre d'Investigation Clinique Antilles-Guyane, CIC Inserm 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | | | - Perrine Molinié
- Centre d'Investigation Clinique Antilles-Guyane, CIC Inserm 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Alexandre Vié
- Centre d'Investigation Clinique Antilles-Guyane, CIC Inserm 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Antoine Adenis
- Centre d'Investigation Clinique Antilles-Guyane, CIC Inserm 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Mathieu Nacher
- Centre d'Investigation Clinique Antilles-Guyane, CIC Inserm 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | | | - Stephen Vreden
- Foundation for the Advancement of Scientific Research in Suriname, Paramaribo, Suriname
| | | | - Alice Sanna
- Centre d'Investigation Clinique Antilles-Guyane, CIC Inserm 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
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Simonet D. Health Care Reforms, Power Concentration, and Receding Citizen Participation. Risk Manag Healthc Policy 2023; 16:1359-1364. [PMID: 37529686 PMCID: PMC10387441 DOI: 10.2147/rmhp.s421397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/06/2023] [Indexed: 08/03/2023] Open
Abstract
The article highlights several outstanding features of French healthcare reforms in light of New Public Management (NPM). The paper exposes the economic, administrative, and social context of reforms. It investigates horizontal integration, as exemplified by the concentration of power within the Regional Health Organizations, the verticalization of the chain of command, and ensuing conflicts between the French welfare elite and the operating core (eg, the medical profession). Outcomes were below expectations in many areas. The NPM-endorsed fragmentation of public organizations has yet to take root in the French healthcare system. There was little consultation with the medical profession. Physicians' autonomy and patients' rights receded.
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Affiliation(s)
- Daniel Simonet
- Department of Management, Strategy & Entrepreneurship, American University of Sharjah, Sharjah, United Arab Emirates
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Tremblay D, Beaupère S, Biaudet J, Castel P, Fervers B, Galvez C, Sontag P, Usher S, Wilhelmy C. Resilience at Work among Healthcare Professionals in Oncology during and beyond the Pandemic: Report from A Deliberative Multi-Stakeholder Reflexive Symposium. Curr Oncol 2023; 30:6986-6995. [PMID: 37504366 PMCID: PMC10377963 DOI: 10.3390/curroncol30070506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/10/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023] Open
Abstract
The chronic distress faced by healthcare professionals (HCPs) in oncology was exacerbated by the COVID-19 pandemic, heightening the need to improve their resilience. The Entretiens Jacques Cartier symposium provided an opportunity for participants from France and Quebec to share perspectives on resilience at work and discuss interventions at individual and organizational levels to support HCP health and well-being. Fifty-eight stakeholders were invited to the symposium, including HCPs, government decision-makers, researchers, and patient representatives. The symposium began with presentations on the nature of professional resilience at work in oncology and promising interventions developed in France and Quebec. Participants were then engaged in deliberation on how evidence and experiential knowledge could contribute to workplace strategies to strengthen resilience. Small-group reflexive sessions using the photovoice method, and an intersectoral roundtable, elicited the expression and deliberation of multiple perspectives on the nature and building blocks of resilience. Four main themes emerged from the discussions: (1) that resilience remains a muddy concept and can be associated pejoratively with "happycracy"; (2) that resilience must contend with bounded autonomy and captors; (3) that it relies on a sense of coherence at work; and (4) that patients play a role in improving HCP resilience. Stakeholders from healthcare systems in different countries view resilience at work as a means of equipping teams to handle chronic and punctual stresses in cancer care. The symposium emphasized the importance of better defining what resilience at work means and pursuing explorations of multicomponent interventions to support oncology HCPs and the patients they care for. The themes raised by participants at the symposium suggest pathways for furthering this exploration.
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Affiliation(s)
- Dominique Tremblay
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC J4K 0A8, Canada
- Centre de Recherche Charles-Le Moyne, Longueuil, QC J4K 0A8, Canada
| | | | - Julien Biaudet
- Cancéropôle Lyon Auvergne Rhône-Alpes, 69007 Lyon, France
| | - Patrick Castel
- Sciences Po, Centre de Sociologie des Organisations (CSO), CNRS, 75007 Paris, France
| | - Béatrice Fervers
- Département Prévention Cancer Environnement, Centre Léon Bérard, 69008 Lyon, France
| | | | | | - Susan Usher
- Commissaire à la Santé et au Bien-Être, Quebec, QC G1S 2L2, Canada
| | - Catherine Wilhelmy
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada
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Schultz É, Mancini J, Ward JK. What does the French public consider to be a conflict of interest for medical researchers? Soc Sci Med 2023; 327:115851. [PMID: 37172337 DOI: 10.1016/j.socscimed.2023.115851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 05/14/2023]
Abstract
Conflicts of interests have been at the core of public debate over health and medicine for decades. Social scientists have analysed the diversity of definitions of this label as well as the policies put in place to regulate the relationships between medical researchers and various actors such as private corporations. But little attention has been paid to the way the public define and use this label. In this article, we assess what the French public consider to be a conflict of interest for medical researchers. We draw on the data from a questionnaire-based survey conducted with a representative sample of the French population in December 2021 (n = 2022) where we asked respondents to decide whether different situations constituted a conflict of interest or not. These situations concerned medical researchers' relationships with economic actors but also with politicians and the media, with or without financial compensation for the researcher. We identified three main group profiles in terms of respondents' conception of what counts as a conflict of interest: i) considering that only money matters in the labelling of a given situation as a conflict of interest, ii) considering that any relationship with economic, media and political actors constitutes a conflict of interest (i.e., that medical research should be an ivory tower), and iii) indecision as to what constitutes a conflict of interest. These three groups differed in terms of social composition as well as respondents' relationships to science, politics, and the health care system.
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Affiliation(s)
- Émilien Schultz
- Sciences Po, Médialab, 1 Place Saint-Thomas d'Aquin, 75007, Paris, France; Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de La Santé & Traitement de L'Information Médicale, ISSPAM, Equipe CANBIOS, Labellisée Ligue Contre le Cancer, Marseille, France.
| | - Julien Mancini
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de La Santé & Traitement de L'Information Médicale, ISSPAM, Equipe CANBIOS, Labellisée Ligue Contre le Cancer, Marseille, France; BioSTIC, APHM, Timone, 13005, Marseille, France
| | - Jeremy K Ward
- Université Paris Cité, CNRS, Inserm, Cermes3, F-94800 Villejuif, France
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Gouesbet S, Kvaskoff M, Riveros C, Diard É, Pane I, Goussé-Breton Z, Valenti M, Gabillet M, Garoche C, Ravaud P, Tran VT. Patients' Perspectives on How to Improve Endometriosis Care: A Large Qualitative Study Within the ComPaRe-Endometriosis e-Cohort. J Womens Health (Larchmt) 2023; 32:463-470. [PMID: 36656556 DOI: 10.1089/jwh.2022.0323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Endometriosis is a chronic gynecological condition that affects about 10% of women of reproductive age. Despite its prevalence, diagnosis is often delayed, misdiagnosis is common, and treatment options are poor. This study aimed at capturing ideas to improve endometriosis care from the patients' perspectives. Materials and Methods: We analyzed cross-sectional data from 1,000 adult patients in ComPaRe-Endometriosis (a French prospective e-cohort focused on endometriosis) who answered to the open-ended question: "If you had a magic wand, what would you change about your health care?". The free-text responses were analyzed by qualitative thematic analysis using an inductive approach. Results: Patients had a mean age of 34.1 years (standard deviation = 8.1); 56% and 42% had stage IV disease or deep endometriosis, respectively. They elicited 2,487 ideas to improve the management of endometriosis, which were categorized into 61 areas of improvement, further grouped into 14 themes. The top five areas of improvement were mentioned by >10% of the patients and were to (1) train caregivers to develop their knowledge on the disease, (2) provide better management of daily pain and pain attacks, (3) take patient-reported symptoms seriously, (4) standardize diagnostic processes to improve early detection, and (5) have caregivers listen more to the patients. Conclusions: We identified 61 areas for improvement in endometriosis care. These results reflect patients' expectations in terms of management of their disease and will be useful to design a better global care for endometriosis from the patients' perspectives.
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Affiliation(s)
- Solène Gouesbet
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP, Villejuif, France.,Center for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Marina Kvaskoff
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP, Villejuif, France
| | - Carolina Riveros
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Élise Diard
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Isabelle Pane
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Zélia Goussé-Breton
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP, Villejuif, France
| | - Michelle Valenti
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP, Villejuif, France
| | | | | | - Philippe Ravaud
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Université de Paris, CRESS, INSERM, INRA, Paris, France.,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Viet-Thi Tran
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Université de Paris, CRESS, INSERM, INRA, Paris, France
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Cognitive Optimisation and Schizophrenia: Assembling Heterogeneity, Overcoming the Precariousness of Life, and Challenging Public Health Policies in Psychiatry in France. Cult Med Psychiatry 2022; 46:710-738. [PMID: 34390458 DOI: 10.1007/s11013-021-09745-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 12/26/2022]
Abstract
Cognitive remediation therapy (CRT) aims to optimise cognitive abilities of people who suffer from schizophrenia in order to improve their social adaptation. This therapeutic orientation was developed in psychiatry in the 1980s and 1990s, at a time when the disorder was being redefined as a neurocognitive deficit disorder. In this article, I describe CRT as an assemblage that lies at the intersection of multiple, overlapping theories and spaces of mental disorders and psychiatric care. To do so, I draw on 18 months of ethnographic research conducted in a French hospital unit dedicated to the development of CRT. I argue that the focus on cognitive health and cognitive abilities (or deficits) is not only redefining the logics of care and reshaping medical conceptualisations of schizophrenia, but it is also opening up to a new understanding of people's precarious life conditions, where emotional, biological, and cognitive fragility is intertwined with social and economic uncertainty. I then examine the extent to which psychiatrists have extended the goals of CRT to include psychosocial rehabilitation in order to mitigate not only the effects of cognitive deficits, but also the effects of limited social and professional integration encountered by patients. Finally, I conclude with a consideration of how CRT has become, for its proponents in France, a means to develop a policy and organisational project for French psychiatry.
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Bizard F. Quelle évolution de notre système de santé pour demain en France ? BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2022. [DOI: 10.1016/j.banm.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Impact of nephrology care trajectories pre-CKD stage 5 on initiation of kidney replacement therapy in children. Pediatr Nephrol 2022; 37:2427-2436. [PMID: 35146540 DOI: 10.1007/s00467-022-05467-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND To improve pre-emptive kidney transplantation (PKT) in children and limit starting dialysis in an emergency, we aimed to describe nephrology care trajectories pre-CKD stage 5. METHODS We included all children in France who, between 2010 and 2016, started kidney replacement therapy (KRT): standard dialysis (reference group) and emergency dialysis or PKT. We identified four pre-CKD stage 5 nephrology care trajectories before KRT that were extracted from the national exhaustive medical-administrative database and used logistic regression to explore associations between patient characteristics, care trajectories, and KRT initiation. RESULTS Six hundred forty-three pediatric patients started KRT in France; 406 started dialysis and 30.5% emergency dialysis. The "optimal" care trajectory encompassed 179 patients, 82.7% with at least 18 months nephrology follow-up. Conversely, the "no care" trajectory encompassed 118 patients with no nephrology follow-up before KRT. The "severe" trajectory encompassed 128 patients; 93% hospitalized more than once a year and 18% in an intensive care unit. Finally, the "irregular" trajectory encompassed 127 patients, 77% and 46% with irregular laboratory monitoring and CKD drug delivery, respectively. With the "optimal" trajectory as the reference, probability of emergency dialysis was higher with the "irregular" and "no care" trajectories (odds ratio 3.02 [95% confidence interval 1.18-7.66] and 26.5 [10.8-64.8], respectively), and PKT was reduced with the "severe" trajectory (0.43 [0.23-0.82]). CONCLUSION We identified a group of patients with irregular follow-up who may benefit the most from interventions aiming at improving adherence to treatment and earlier diagnosis of their CKD to improve access to PKT. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Bell-Aldeghi R, Sirven N, Le Guern M, Sevilla-Dedieu C. One last effort. Are high out-of-pocket payments at the end of life a fatality? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:879-891. [PMID: 35098353 DOI: 10.1007/s10198-021-01401-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 10/27/2021] [Indexed: 06/14/2023]
Abstract
Only few studies outside of the US have addressed the issue of out-of-pocket payments (OOP) at the end of life because of a lack of data. We use an exclusive dataset from a major French health insurance company (MGEN), including claim data, both mandatory and voluntary health insurance details, income and individual characteristics, for individuals aged 65 or older who died in 2017. We address three main issues: (1) What is the magnitude of OOP in France at the end of life? (2) How are OOP distributed, and do they present a financial risk to patients? (3) What are the determinants of OOP and what health system reforms could reduce them? Our results indicate that OOP expenses increase in the last year of life and accelerate in the last trimester. Despite some outliers, the French system is successful in protecting individuals from catastrophic OOP. Using generalised linear models, we confirm that improving the pathways of care could generate savings and partially reduce households' financial burden. However, OOP are elastic to income and driven essentially by personal convenience demands. Using concentration curves and Gini coefficients, we show that providing additional insurance against end-of-life OOP would likely be regressive, i.e., socially non-desirable.
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Affiliation(s)
- Rosalind Bell-Aldeghi
- MGEN Foundation for Public Health, 3 sq Max Hymans, 75015, Paris, France.
- Universite de Paris, LIRAES, Chair of Innovation and Value in Health, 75006, Paris, France.
| | - Nicolas Sirven
- Arènes (UMR CNRS 6051), École des Hautes Études en Santé Publique, Rennes, France
- IRDES, Institut de Recherche et Documentation en Économie de la Santé, Paris, France
| | - Morgane Le Guern
- MGEN Foundation for Public Health, 3 sq Max Hymans, 75015, Paris, France
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13
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Harkouk H, Castel P, Hervouët L, Fletcher D. Qualitative analysis of the organisational response of a university hospital during the first wave of the COVID-19 crisis. BMJ Open Qual 2022; 11:bmjoq-2022-001817. [PMID: 35701045 PMCID: PMC9198384 DOI: 10.1136/bmjoq-2022-001817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 06/04/2022] [Indexed: 11/29/2022] Open
Abstract
Background The COVID-19 pandemic has required urgent organisational and managerial adaptation, with hospital medical and administrative leaders under considerable pressure. Methods At a single French university hospital, we performed a sociological analysis of management adaptation by medical and administrative leaders during the first wave of the COVID-19 crisis. Two sociologists performed interviews with representative members of staff from all the structures involved in managing the crisis to analyse adaptation and the solutions found during this period. Results The answers collected during interviews were classified into three main topics describing the organisational adaptations of the hospital staff during the COVID-19 crisis: (1) exceptional mobilisation and collaboration; (2) crisis management based primarily on the principle of subsidiarity; and (3) survival of the administrative structure with interventions to support caregivers. Conclusion This study, focusing on a single hospital, identified a number of factors associated with successful mobilisation in the very specific conditions of this viral pandemic.
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Affiliation(s)
- Hakim Harkouk
- Service d'anesthésie, Hôpital Ambroise Paré, Assistance Publique - Hopitaux de Paris, Boulogne Billancourt, France
| | - Patrick Castel
- Centre de Sociologie des organisations, CNRS, Paris, Île-de-France, France
- Centre de Sociologie des organisations, Sciences Po, Paris, Île-de-France, France
| | - Lucile Hervouët
- Centre de Sociologie des organisations, Sciences Po, Paris, Île-de-France, France
| | - Dominique Fletcher
- Service d'anesthésie, Hôpital Ambroise Paré, Assistance Publique - Hopitaux de Paris, Boulogne Billancourt, France
- Health Sciences, Versailles Saint-Quentin-en-Yvelines University, Versailles, Île-de-France, France
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14
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Debie A, Khatri RB, Assefa Y. Successes and challenges of health systems governance towards universal health coverage and global health security: a narrative review and synthesis of the literature. Health Res Policy Syst 2022; 20:50. [PMID: 35501898 PMCID: PMC9059443 DOI: 10.1186/s12961-022-00858-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 04/13/2022] [Indexed: 01/15/2023] Open
Abstract
Background The shift in the global burden of disease from communicable to noncommunicable was a factor in mobilizing support for a broader post-Millennium Development Goals (MDGs) health agenda. To curb these and other global health problems, 193 Member States of the United Nations (UN) became signatories of the Sustainable Development Goals (SDGs) and committed to achieving universal health coverage (UHC) by 2030. In the context of the coronavirus disease 2019 (COVID-19) pandemic, the importance of health systems governance (HSG) is felt now more than ever for addressing the pandemic and continuing to provide essential health services. However, little is known about the successes and challenges of HSG with respect to UHC and health security. This study, therefore, aims to synthesize the evidence and identify successes and challenges of HSG towards UHC and health security. Methods We conducted a structured narrative review of studies published through 28 July 2021. We searched the existing literature using three databases: PubMed, Scopus and Web of Science. Search terms included three themes: HSG, UHC and health security. We synthesized the findings using the five core functions of HSG: policy formulation and strategic plans; intelligence; regulation; collaboration and coalition; and accountability. Results A total of 58 articles were included in the final review. We identified that context-specific health policy and health financing modalities helped to speed up the progress towards UHC and health security. Robust health intelligence, intersectoral collaboration and coalition were also essential to combat the pandemic and ensure the delivery of essential health services. On the contrary, execution of a one-size-fits-all HSG approach, lack of healthcare funding, corruption, inadequate health workforce, and weak regulatory and health government policies were major challenges to achieving UHC and health security. Conclusions Countries, individually and collectively, need strong HSG to speed up the progress towards UHC and health security. Decentralization of health services to grass root levels, support of stakeholders, fair contribution and distribution of resources are essential to support the implementation of programmes towards UHC and health security. It is also vital to ensure independent regulatory accreditation of organizations in the health system and to integrate quality- and equity-related health service indicators into the national social protection monitoring and evaluation system; these will speed up the progress towards UHC and health security. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-022-00858-7.
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Affiliation(s)
- Ayal Debie
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia.
| | - Resham B Khatri
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Australia
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15
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Douillet D, Dupont C, Leloup N, Ménager G, Delori M, Soulie C, Morin F, Moumneh T, Savary D, Roy PM, Armand A. Prevalence and characterization of forgoing care: comparison of two prospective multicentre cohorts between pre-COVID-19 era and a lockdown period. Arch Public Health 2022; 80:32. [PMID: 35042548 PMCID: PMC8766360 DOI: 10.1186/s13690-022-00797-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 01/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about patients who forego healthcare, although it is an important provider of unfavorable health-related outcomes. Forgoing healthcare characterizes situations in which people do not initiate or interrupt a care process, even though they perceive the need for it, whether or not this need is medically proven. The aims of this study were to assess the prevalence and the determinants of patients who forego healthcare. The second aim was to compare the characteristics of patients who gave up healthcare during the French lockdown due to COVID-19. METHODS We conducted two multicenter cross-sectional studies in 2017 and 2020 carried out in French patients presenting to the emergency departments. Patients who gave their consent to participate were interviewed with a standardized questionnaire. It consisted of two parts: epidemiological characteristics and health care refusal. A third part concerning the renunciation of care during the COVID-19 period was added to the second study period. RESULTS A total of 1878 patients had completed the questionnaire during the interview with the physicians, 900 during the first period in 2017 (47.9%) and 978 (52.1%) during the second period. A total of 401/1878 patients reported not seeking care in the last 12 months (21.4% [95%CI: 19.5-23.3%]). In 2020, patients forewent care more during the confinement period than outside with different characteristics of the foregoing care populations. CONCLUSION Forgoing care is common in a universal health care system such as France's and increased during the pandemic. Key public health messages targeted at the reasons for not seeking care must now be disseminated in order to combat this.
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Affiliation(s)
- Delphine Douillet
- Emergency Department, Angers University Hospital, UNIV Angers, Angers, France. .,UMR MitoVasc CNRS 6015 - INSERM 1083, Health Faculty, Angers, France.
| | - Clémence Dupont
- Emergency Department, Angers University Hospital, UNIV Angers, Angers, France
| | - Noémie Leloup
- Emergency Department, Le Mans Hospital, Le Mans, France
| | | | - Maud Delori
- Emergency Department, Angers University Hospital, UNIV Angers, Angers, France
| | | | - François Morin
- Emergency Department, Angers University Hospital, UNIV Angers, Angers, France
| | - Thomas Moumneh
- Emergency Department, Angers University Hospital, UNIV Angers, Angers, France.,UMR MitoVasc CNRS 6015 - INSERM 1083, Health Faculty, Angers, France
| | - Dominique Savary
- Emergency Department, Angers University Hospital, UNIV Angers, Angers, France.,EHESP, Irset, Inserm, UMR S1085, CAPTV CDC, University of Rennes, Rennes, France
| | - Pierre-Marie Roy
- Emergency Department, Angers University Hospital, UNIV Angers, Angers, France.,UMR MitoVasc CNRS 6015 - INSERM 1083, Health Faculty, Angers, France
| | - Aurore Armand
- Emergency Department, Angers University Hospital, UNIV Angers, Angers, France.,République des Savoirs- Lettres, Sciences, Philosophie - USR3608- ED540- ENS-PSL, Paris, France
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16
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Najah H, Duffillot C, Gronnier C, Lescarret B, Saubusse E, Collet D, Gatta-Cherifi B, Montsaingeon-Henry M. Guideline compliance in bariatric surgery: a French nationwide study. Surg Obes Relat Dis 2021; 18:620-627. [PMID: 35065888 DOI: 10.1016/j.soard.2021.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/30/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Strict adherence to guidelines with a comprehensive preoperative assessment and rigorous follow-up are essential to improve postoperative and long-term outcomes of bariatric surgery (BS). OBJECTIVES To investigate the trends in BS in France and to assess the compliance to guidelines in people with obesity before and after BS. SETTING University Hospital of Bordeaux, France. METHODS Data on patients who were admitted for a primary BS procedure in France between January 1 and April 1, 2014, were extracted from the French national health insurance system database. Data on patients' characteristics, preoperative assessment, hospitalization, and postoperative follow-up, including medical consultations, laboratory tests, and drug consumption, during the year preceding and the 2 years after BS were collected. RESULTS Most of the 11,824 patients (60.4%) had sleeve gastrectomy. Rates of reimbursement for preoperative consultations with general practitioners, digestive surgeons, and endocrinologists or internists were 94.5%, 89.2%, and 63%, respectively. Laboratory tests for nutritional and obesity-related co-morbidity evaluations were performed in 94.3% and 91.4%, respectively. Rates of consultation with general practitioners, digestive surgeons, and endocrinologists or internists dropped from 93.1%, 91.2%, and 29.2%, respectively, the first year to 88.4%, 50.3%, and 20%, respectively, the second year after BS (P < .001). Reimbursements for vitamin, iron, and calcium supplementation dropped from 66.6%, 24.9%, and 21%, respectively, the first year to 52.1%, 19.3%, and 11.7%, respectively, the second year after BS (P < .001). CONCLUSION Overall compliance with guidelines is improving. While preoperative medical assessment is nearly optimal, efforts still should be made in order to improve long-term follow-up in general and patient adherence to micronutrient supplementation in particular.
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Affiliation(s)
- Haythem Najah
- Department of Digestive and Endocrine Surgery, Magellan Center, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France.
| | - Coralie Duffillot
- Endocrinology and Nutrition Department, INSERM Unit 1215, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Caroline Gronnier
- Department of Digestive and Endocrine Surgery, Magellan Center, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | | | | | - Denis Collet
- Department of Digestive and Endocrine Surgery, Magellan Center, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Blandine Gatta-Cherifi
- Endocrinology and Nutrition Department, INSERM Unit 1215, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Maud Montsaingeon-Henry
- Endocrinology and Nutrition Department, INSERM Unit 1215, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
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17
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Papot E, Kalampalikis N, Doumergue M, Pilorgé F, Quatremère G, Yazdanpanah Y, Préau M. Can we talk about price with patients when choosing antiretroviral therapy? A survey with people living with HIV and prescribers in France. BMJ Open 2021; 11:e046212. [PMID: 34836895 PMCID: PMC8628338 DOI: 10.1136/bmjopen-2020-046212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate people living with HIV (PLWH) and HIV specialist prescribers' perception of discussing antiretroviral therapy (ART) price in PLWH's care and the acceptability of choosing or switching to various types of less expensive ARTs. DESIGN Cross-sectional surveys (one in a convenience sample of PLWH and one in a voluntary response sample of HIV specialist prescribers). SETTING AND PARTICIPANTS The surveys were conducted among PLHW attending an HIV clinic in the North of Paris (cohort of 4922 PLWH in 2016), and HIV specialists working in French HIV clinics (210 across 12 districts/28), between January and June 2016. METHOD Self-administered questionnaires were constructed using data collected during focus groups with PLWH and prescribers. Pretests were carried out to select the questions and items. Descriptive analyses of the 129 complete questionnaires of PLWH and 79 of prescribers are presented. RESULTS Among PLWH, 128/129 were on ART and 54% (69/128) gave a fair estimation of the price of their current regimen. Among prescribers, 24% (19/79) thought that their patients knew this price. Taking into account the price of ART was not perceived as a negative step in the history of French response to HIV epidemic for 53% (68/129) of PLWH and 82% (65/79) of prescribers. Seventy-seven PLWH (60%) would agree to switch to less expensive antiretroviral regimens (as effective and with similar adverse events) if pills were bigger; 42 (33%) if there were more daily doses, and 37 (29%) if there were more pills per dose; prescribers were more circumspect. CONCLUSION A high proportion of PLWH gave a fair estimate of their ART price and this seemed unexpected by HIV specialists. Consideration of drug prices when choosing ART was perceived as conceivable by PLWH and prescribers if effectiveness and tolerance were also considered.
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Affiliation(s)
- Emmanuelle Papot
- Université de Paris, INSERM, IAME, F-75006, INSERM, Paris, France
- AP-HP, Hôpital Bichat, Infectious and Tropical Diseases Department, F-75018 Paris, France
| | | | | | | | | | - Yazdan Yazdanpanah
- Université de Paris, INSERM, IAME, F-75006, INSERM, Paris, France
- AP-HP, Hôpital Bichat, Infectious and Tropical Diseases Department, F-75018 Paris, France
| | - Marie Préau
- UMR 1296 « Radiations : Défense, Santé, Environnement », Université Lumière Lyon 2, Institut de Psychologie, Bron, France
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18
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Moses MW, Korir J, Zeng W, Musiega A, Oyasi J, Lu R, Chuma J, Di Giorgio L. Performance assessment of the county healthcare systems in Kenya: a mixed-methods analysis. BMJ Glob Health 2021; 6:e004707. [PMID: 34167962 PMCID: PMC8230973 DOI: 10.1136/bmjgh-2020-004707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION A well performing public healthcare system is necessary for Kenya to continue progress towards universal health coverage (UHC). Identifying actionable measures to improve the performance of the public healthcare system is critical to progress towards UHC. We aimed to measure and compare the performance of Kenya's public healthcare system at the county level and explore remediable drivers of poor healthcare system performance. METHODS Using administrative data from fiscal year 2014/2015 through fiscal year 2017/2018, we measured the technical efficiency of 47 county-level public healthcare systems in Kenya using stochastic frontier analysis. We then regressed the technical efficiency measure against a set of explanatory variables to examine drivers of efficiency. Additionally, in selected counties, we analysed surveys and focus group discussions to qualitatively understand factors affecting performance. RESULTS The median technical efficiency of county public healthcare systems was 84% in fiscal year 2017/2018 (with an IQR of 79% to 90%). Across the four fiscal years of data, 27 out of the 47 Kenyan counties had a declining technical efficiency score. Our regression analysis indicated that impediments to the flow of funding-measured by the budget absorption rate which is the ratio between funds spent and funds released-were significantly related to poor healthcare system performance. Our analysis of interviews and surveys yielded a similar conclusion as nearly 50% of respondents indicated issues stemming from poor budget absorption were significant drivers of poor healthcare system performance. CONCLUSION Public healthcare systems at the county-level in Kenya general performed well; however, addressing delays in the flow of funding is a concrete step to improve healthcare system performance. As Kenya-and other countries-provides additional funding to meet their UHC goals, establishing a strong and robust public financial management system is critical to ensure that the benefits of UHC are realised.
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Affiliation(s)
| | - Julius Korir
- School of Economics, Kenyatta University, Nairobi, Kenya
| | - Wu Zeng
- Department of International Health, School of Nursing & Health Studies, Georgetown University, Washington, DC, USA
| | - Anita Musiega
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | | | - Ruoyan Lu
- School of Public Health, Fujian Medical University, Fujian, China
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19
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Revet A, Moulis G, Raynaud JP, Bui E, Lapeyre-Mestre M. Use of the French national health insurance information system for research in the field of mental health: Systematic review and perspectives. Fundam Clin Pharmacol 2021; 36:16-34. [PMID: 33998708 DOI: 10.1111/fcp.12696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE This systematic review registered in PROSPERO (CRD42021225296) aimed to describe the use of the French national health insurance information system, which covers the entire French population (67 million inhabitants), for research in the field of mental health. METHODS Three electronic databases and a journal hand-search identified 15 265 articles from January 1, 2003 (year of creation of the database) to October 31, 2020. Studies of any design were eligible for inclusion provided that they (i) made use of at least one component of the French health insurance database and (ii) focused on a topic in near and far connection with the field of mental health in France. Database used, design and methods, study period, population, key findings, and type of use for medical research were described. RESULTS A total of 152 studies were included in the review analysis. There was an increase in the number of published articles over time throughout the studied period. Studies focusing on adults (n = 139) largely outnumbered those focusing on children and adolescents (n = 11). Pharmacoepidemiological studies were by far the most frequent (n = 123), followed by methodological studies (n = 23), epidemiological studies (n = 17), and health economics studies (n = 3). The most studied psychotropic drugs were antidepressants (n = 27), anxiolytics (n = 27), and opioids (n = 25) while fewer studies focused on methylphenidate (n = 6) and on mood stabilizers (n = 5). Few studies specifically focused on psychiatric disorders, mainly depression (n = 4), suicide (n = 4), and psychotic disorders (n = 3). CONCLUSION This systematic review highlighted a relatively poor exploitation of the Système national des données de santé database in the field of psychiatric research with regard to the great possibilities it offers, with a clear lag in certain fields such as epidemiological or health economics studies and in specific populations, in particular children and adolescents.
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Affiliation(s)
- Alexis Revet
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Toulouse, Toulouse, France.,CERPOP, Inserm, UPS, Université de Toulouse, Toulouse, France.,CIC 1436, Team PEPSS "Pharmacologie En Population cohorteS et biobanqueS", Toulouse University Hospital, Toulouse, France
| | - Guillaume Moulis
- CIC 1436, Team PEPSS "Pharmacologie En Population cohorteS et biobanqueS", Toulouse University Hospital, Toulouse, France.,Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Jean-Philippe Raynaud
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Toulouse, Toulouse, France.,CERPOP, Inserm, UPS, Université de Toulouse, Toulouse, France
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Caen University Hospital, University of Caen Normandy, Caen, France
| | - Maryse Lapeyre-Mestre
- CIC 1436, Team PEPSS "Pharmacologie En Population cohorteS et biobanqueS", Toulouse University Hospital, Toulouse, France
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20
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Rodwin MA. Common Pharmaceutical Price and Cost Controls in the United Kingdom, France, and Germany: Lessons for the United States. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2021; 51:379-391. [DOI: 10.1177/0020731421996168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To identify pharmaceutical spending-control options for the United States, we analyzed the policies of the United Kingdom, France, and Germany, which encourage drugmakers to undertake innovations that improve health while controlling spending. Their main strategies today include: using legislation to set default rules that increase the insurer's bargaining position, employing health technology assessment that measures cost-effectiveness or comparative effectiveness and caps the purchase or reimbursement price, setting a single maximum price for similar drugs (reference group pricing), capping prices near prices in other European countries (external reference pricing), prohibiting price increases, contracting to obtain discounts as sales volume rises, procuring drugs through competitive bids, and requiring manufacturers to pay rebates when spending exceeds a global budget. Each strategy addresses a distinct cause of high spending and supports overall goals. Most recent US reform proposals recommend incremental changes that would not address the major sources of high and increasing pharmaceutical prices. However, some US reform proposals resemble certain European strategies and could bring more significant change. US policymakers should consider adopting each of the strategies employed in these countries.
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21
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Schultz É, Ward JK, Atlani-Duault L, Holmes SM, Mancini J. French Public Familiarity and Attitudes toward Clinical Research during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052611. [PMID: 33807787 PMCID: PMC7967331 DOI: 10.3390/ijerph18052611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 01/18/2023]
Abstract
The COVID-19 pandemic put clinical research in the media spotlight globally. This article proposes a first measure of familiarity with and attitude toward clinical research in France. Drawing from the “Health Literacy Survey 2019” (HLS19) conducted online between 27 May and 5 June 2020 on a sample of the French adult population (N = 1003), we show that a significant proportion of the French population claimed some familiarity with clinical trials (64.8%) and had positive attitudes (72%) toward them. One of the important findings of this study is that positive attitudes toward clinical research exist side by side with a strong distancing from the pharmaceutical industry. While respondents acknowledged that the pharmaceutical industry plays an important role in clinical research (68.3%), only one-quarter indicated that they trust the industry (25.7%). Positive attitudes toward clinical trials were associated with familiarity with clinical trials (Odds Ratio, OR 2.97 [1.90–4.63]), financial difficulties (OR 0.63 [0.46–0.85]), as well as mistrust of doctors (0.48 [0.27–0.85]) and of scientists (OR 0.62 [0.38–0.99]). Although the French media provided a great deal of information on how clinical research works during the first months of the pandemic, there remains profound mistrust of the pharmaceutical industry in France. This suspicion can undermine crisis management, especially in the areas of vaccine development and preparation for future pandemics.
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Affiliation(s)
- Émilien Schultz
- CEPED (UMR 196), Université de Paris, IRD, 75006 Paris, France;
- SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, CANBIOS Team (Équipe Labellisée LIGUE 2019), Aix-Marseille University, INSERM, IRD, 13009 Marseille, France; (S.M.H.); (J.M.)
- Correspondence:
| | - Jeremy K. Ward
- CERMES3, INSERM, CNRS, EHESS, Université de Paris, 94801 Villejuif, France;
- VITROME, Aix-Marseille University, IRD, AP-HM, SSA, 13005 Marseille, France
| | - Laëtitia Atlani-Duault
- CEPED (UMR 196), Université de Paris, IRD, 75006 Paris, France;
- Institut COVID-19 Add Memoriam, University of Paris, 75006 Paris, France
- WHO Collaborative Center for Research on Health and Humanitarian Policies and Practices, IRD, Université de Paris, 75006 Paris, France
| | - Seth M. Holmes
- SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, CANBIOS Team (Équipe Labellisée LIGUE 2019), Aix-Marseille University, INSERM, IRD, 13009 Marseille, France; (S.M.H.); (J.M.)
- Society and Environment, Medical Anthropology, and Public Health, University of Berkeley, Berkeley, CA 94720, USA
- Mediterranean Institute for Advanced Study IMéRA, Institut Paoli Calmettes, Aix-Marseille University, 13004 Marseille, France
| | - Julien Mancini
- SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, CANBIOS Team (Équipe Labellisée LIGUE 2019), Aix-Marseille University, INSERM, IRD, 13009 Marseille, France; (S.M.H.); (J.M.)
- BioSTIC, APHM, Timone, 13005 Marseille, France
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22
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Chamberlain JD, Rouanet A, Dubois B, Pasquier F, Hanon O, Gabelle A, Ceccaldi M, Krolak-Salmon P, Béjot Y, Godefroy O, Wallon D, Gentric A, Chêne G, Dufouil C. Investigating the association between cancer and the risk of dementia: Results from the Memento cohort. Alzheimers Dement 2021; 17:1415-1421. [PMID: 33656287 PMCID: PMC8518910 DOI: 10.1002/alz.12308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/07/2021] [Accepted: 01/18/2021] [Indexed: 12/21/2022]
Abstract
Introduction Studies on the association of cancer and risk of dementia are inconclusive due to result heterogeneity and concerns of survivor bias and unmeasured confounding. Methods This study uses data from the Memento cohort, a French multicenter cohort following persons with either mild or isolated cognitive complaints for a median of 5 years. Illness‐death models (IDMs) were used to estimate transition‐specific hazard ratios (HRs) and 95% confidence intervals (CIs) for incident cancer in relation to dementia from time since study entry. Results The analytical sample (N = 2258) excluded 65 individuals without follow‐up information. At the end of follow‐up, 286 individuals were diagnosed with dementia, 166 with incident cancer, and 95 died. Incident cancer was associated with a reduced risk of dementia (HR = 0.58, 95% CI = 0.35‐0.97), with a corresponding E‐value of 2.84 (lower CI = 1.21). Discussion This study supports a protective relationship between incident cancer and dementia, encouraging further investigations to understand potential underlying mechanisms.
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Affiliation(s)
- Jonviea D Chamberlain
- Bordeaux Population Health Research Center, UMR 1219, University of Bordeaux, Inserm, Bordeaux, France.,CIC1401-EC, Inserm, Bordeaux, France
| | - Anaïs Rouanet
- Bordeaux Population Health Research Center, UMR 1219, University of Bordeaux, Inserm, Bordeaux, France
| | - Bruno Dubois
- Sorbonne Université, AP-HP, Hôpital de la Pitié-Salpêtrière, Boulevard de l'hôpital, Paris, France
| | | | - Olivier Hanon
- EA 4468, Université de Paris, Geriatric department Broca hospital, APHP, Paris, France
| | - Audrey Gabelle
- Centre Mémoire Ressources Recherche Département de Neurologie CHU Gui de Chauliac, Montpellier, France
| | - Mathieu Ceccaldi
- Ouest CHU Timone APHM & Aix Marseille Univ INSERM INS Inst Neurosci Syst, CMMR PACA, Marseille, France
| | | | - Yannick Béjot
- Department of Neurology and Memory Resource and Research Center of Dijon, EA7460, University Hospital of Dijon, University of Burgundy, Dijon, France
| | - Olivier Godefroy
- Neurology Department, Amiens University Hospital, Amiens, France
| | - David Wallon
- Functional Neurosciences Lab (UR UPJV4559), Centre Universitaire de Recherche en Santé, Normandie Univ, UNIROUEN, Department of Neurology and CNR-MAJ, Inserm U1245 and Rouen University Hospital, Rouen, France
| | | | - Geneviève Chêne
- CIC1401-EC, Inserm, Bordeaux, France.,Pole de sante publique Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Carole Dufouil
- CIC1401-EC, Inserm, Bordeaux, France.,Pole de sante publique Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
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Nerich V, Gamper EM, Norman R, King M, Holzner B, Viney R, Kemmler G. French Value-Set of the QLU-C10D, a Cancer-Specific Utility Measure Derived from the QLQ-C30. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:191-202. [PMID: 32537694 DOI: 10.1007/s40258-020-00598-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND AND OBJECTIVE The EORTC Quality of Life Utility Measure-Core 10 Dimensions (QLU-C10D) is a new multi-attribute utility instrument derived from the EORTC Quality of Life Questionnaire-Core 30 (QLQ-C30), a widely used cancer-specific quality-of-life questionnaire. It covers ten dimensions: physical, role functioning, social, emotional functioning, pain, fatigue, sleep, appetite, nausea and bowel problems. To allow national health preferences to be reflected, country-specific valuations are being performed through collaboration between the Multi-Attribute Utility Cancer (MAUCa) Consortium and the EORTC. The aim of this study was to determine the utility weights for health states in the French version of the QLU-C10D. METHODS Valuations were run in a web-based setting in a general population sample of 1033 adults. Utilities were elicited using a discrete-choice experiment (DCE). Data were analyzed by conditional logistic regression and mixed logits. RESULTS The sample was representative of the general French population in terms of gender and age. Dimensions with the largest impact on utility weights were, in this order: physical functioning, pain and emotional functioning. The impact on utilities was lower for role functioning, nausea, bowel problems and social functioning. The dimensions of sleep, fatigue and lacking appetite were associated with the smallest utility decrement. CONCLUSION The results of the present study provide utility weights for the QLU-C10D and offer interesting prospects, as some cancer-specific dimensions also received sizeable utility weights (nausea and bowel problems). In fact, the EQ-5D and the HUI 3 are recommended in France and commonly used for cancer-related CUA; however, both these instruments are generic. The availability of a new cancer-specific utility instrument, such as the QLU-C10D, could improve the quality and the pertinence of future CUA in oncology.
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Affiliation(s)
- Virginie Nerich
- Department of Pharmacy, University Hospital, Boulevard Fleming, 25030, Besancon Cedex, France.
- INSERM, EFS-BFC, UMR1098, University of Franche-Comté, Besançon, France.
| | - Eva Maria Gamper
- Division of Psychiatry II, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Richard Norman
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Madeleine King
- School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
- Sydney Medical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Bernhard Holzner
- Division of Psychiatry II, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Rosalie Viney
- Centre for for Health Economics Research and Evaluation (CHERE), UTS Business School University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Georg Kemmler
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
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Rosenwohl-Mack A, Dubbin L, Chodos A, Dulaney S, Fang ML, Merrilees J, Portacolone E. Use of Services by People Living Alone With Cognitive Impairment: A Systematic Review. Innov Aging 2021; 5:igab004. [PMID: 33796795 PMCID: PMC7990060 DOI: 10.1093/geroni/igab004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Formal supports and social services are essential to people living alone with cognitive impairment (PLACI) because they are at risk of negative health outcomes and lack cohabitants who may support them with cognitively demanding tasks. To further our understanding of this critical and worldwide issue, we conducted a systematic review to understand whether, and how, PLACI access and use essential formal supports and services. RESEARCH DESIGN AND METHODS We searched 6 databases (PubMed, Embase, PsycINFO, CINAHL, Web of Science, and Sociological Abstracts) to identify quantitative and mixed-method literature on formal service use among PLACI. The initial search was conducted in 2018 and updated in 2020. RESULTS We identified 32 studies published between 1992 and 2019, representing 13 countries, that met our criteria: 16 reported on health services and 26 on social services. Most studies compared PLACI with people with cognitive impairment living with others. Health service use was lower or similar among PLACI, as opposed to counterparts living with others. Most studies reported a higher use of social services (e.g., home services) among PLACI than those living with others. Overall use of essential home service among PLACI was higher in Europe than in the United States, a country where large portions of PLACI were reported receiving no formal services. DISCUSSION AND IMPLICATIONS We identified wide variability among countries and major gaps in service use. Results for use of health services were mixed, although our findings suggest that PLACI may have fewer physician visits than counterparts living with others. Our findings suggest that varying policies and budgets for these services among countries may have affected our findings. We encourage researchers to evaluate and compare the influence of social policies in the well-being of PLACI. We also encourage policy makers to prioritize the needs of PLACI in national dementia strategies.
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Affiliation(s)
- Amy Rosenwohl-Mack
- Department of Social and Behavioral Sciences, School of Nursing, University of California San Francisco, USA
| | - Leslie Dubbin
- Department of Social and Behavioral Sciences, School of Nursing, University of California San Francisco, USA
| | - Anna Chodos
- Division of Geriatrics, University of California San Francisco, USA
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, USA
| | - Sarah Dulaney
- Memory and Aging Center, University of California San Francisco, USA
| | - Min-Lin Fang
- Library, University of California San Francisco, USA
| | | | - Elena Portacolone
- Institute for Health & Aging, University of California San Francisco, USA
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25
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Field RI, Keller C, Louazel M. Can governments push providers to collaborate? A comparison of hospital network reforms in France and the United States. Health Policy 2020; 124:1100-1107. [DOI: 10.1016/j.healthpol.2020.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 06/12/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
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Association between Migrant Women's Legal Status and Prenatal Care Utilization in the PreCARE Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197174. [PMID: 33007972 PMCID: PMC7579291 DOI: 10.3390/ijerph17197174] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 11/16/2022]
Abstract
Barriers to access to prenatal care may partially explain the higher risk of adverse pregnancy outcomes among migrants compared with native-born women in Europe. Our aim was to assess the association between women's legal status and inadequate prenatal care utilization (PCU) in France, where access to healthcare is supposed to be universal. The study population was extracted from the PreCARE prospective cohort (N = 10,419). The associations between women's legal status and a composite outcome variable of inadequate PCU were assessed with multivariate logistic regressions. The proportion of women born in sub-Saharan Africa (SSA) was higher among the undocumented than that of other migrants. All groups of migrant women had a higher risk of inadequate PCU (31.6% for legal migrants with European nationalities, 40.3% for other legal migrants, and 52.0% for undocumented migrants) than French-born women (26.4%). The adjusted odds ratio (aOR) for inadequate PCU for undocumented migrants compared with that for French-born women was 2.58 (95% confidence interval 2.16-3.07) overall, and this association was similar for migrant women born in SSA (aOR 2.95, 2.28-3.82) and those born elsewhere (aOR 2.37, 1.89-2.97). Regardless of the maternal place of birth, undocumented migrant status is associated with a higher risk of inadequate PCU.
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Kembou Nzale S, Weeks WB, Ouafik L, Rouquette I, Beau-Faller M, Lemoine A, Bringuier PP, Le Coroller Soriano AG, Barlesi F, Ventelou B. Inequity in access to personalized medicine in France: Evidences from analysis of geo variations in the access to molecular profiling among advanced non-small-cell lung cancer patients: Results from the IFCT Biomarkers France Study. PLoS One 2020; 15:e0234387. [PMID: 32609781 PMCID: PMC7329126 DOI: 10.1371/journal.pone.0234387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 05/26/2020] [Indexed: 11/19/2022] Open
Abstract
In this article, we studied geographic variation in the use of personalized genetic testing for advanced non-small cell lung cancer (NSCLC) and we evaluated the relationship between genetic testing rates and local socioeconomic and ecological variables. We used data on all advanced NSCLC patients who had a genetic test between April 2012 and April 2013 in France in the frame of the IFCT Biomarqueurs-France study (n = 15814). We computed four established measures of geographic variation of the sex-adjusted rates of genetic testing utilization at the "départment" (the French territory is divided into 94 administrative units called 'départements') level. We also performed a spatial regression model to determine the relationship between département-level sex-adjusted rates of genetic testing utilization and economic and ecological variables. Our results are the following: (i) Overall, 46.87% lung cancer admission patients obtained genetic testing for NSCLC; département-level utilization rates varied over 3.2-fold. Measures of geographic variation indicated a relatively high degree of geographic variation. (ii) there was a statistically significant relationship between genetic testing rates and per capita supply of general practitioners, radiotherapists and surgeons (negative correlation for the latter); lower genetic testing rates were also associated with higher local poverty rates. French policymakers should pursue effort toward deprived areas to obtain equal access to personalized medicine for advanced NSCLC patients.
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Affiliation(s)
- Samuel Kembou Nzale
- Aix-Marseille Univ., CNRS, EHESS, Centrale Marseille, AMSE, Marseille, France
| | - William B. Weeks
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Building, DHMC, Lebanon, NH, United States of America
| | - L’Houcine Ouafik
- Assistance Publique Hôpitaux de Marseille, Service de Transfert d'Oncologie Biologique, Aix-Marseille Univ, Marseille, France
| | - Isabelle Rouquette
- Institut Universitaire du Cancer de Toulouse, Oncopôle, Service d'Anatomie Pathologique, Toulouse, France
| | - Michèle Beau-Faller
- Centre Hospitalier Universitaire de Hautepierre, Laboratoire de Biochimie et de Biologie Moléculaire & Plate-forme de Génomique des Cancers, Strasbourg, France
| | - Antoinette Lemoine
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier des Hôpitaux Universitaires Paris-Sud, Service d'Oncogénétique- Oncomolpath, Université Paris 11, Villejuif, France
| | - Pierre-Paul Bringuier
- Hôpital Edouard Herriot, Service d'Anatomie et de Cytologie Pathologique, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon Cancer Research Center, UMR 1057 INSERM, Lyon, France
| | - Anne-Gaëlle Le Coroller Soriano
- Mixed Research Unit 912, Institute of Research and Development, National Institute of Health and Medical Research, Paoli Calmettes Institute, Aix-Marseille University, Marseille, France
- * E-mail:
| | - Fabrice Barlesi
- Assistance Publique Hôpitaux de Marseille, Multidisciplinary Oncology and Therapeutic Innovations Department, Aix-Marseille Univ, Centre d'Investigation Clinique, Marseille, France
| | - Bruno Ventelou
- Aix-Marseille Univ., CNRS, EHESS, Centrale Marseille, AMSE, Marseille, France
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Feral-Pierssens AL, Rives-Lange C, Matta J, Rodwin VG, Goldberg M, Juvin P, Zins M, Carette C, Czernichow S. Forgoing health care under universal health insurance: the case of France. Int J Public Health 2020; 65:617-625. [PMID: 32474715 DOI: 10.1007/s00038-020-01395-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/08/2020] [Accepted: 05/19/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We investigate the reliability of a survey question on forgone healthcare services for financial reasons, based on analysis of actual healthcare use over the 3-year period preceding response to the question. We compare the actual use of different health services by patients who report having forgone health care to those who do not. METHODS Based on a prospective cohort study (CONSTANCES), we link survey data from enrolled participants to the Universal Health Insurance (UHI) claims database and compare use of health services of those who report having forgone health care to controls. We present multivariable logistic regression models and assess the odds of using different health services. RESULTS Compared to controls, forgoing care participants had lower odds of consulting GPs (OR = 0.83; 95% CI 0.73, 0.93), especially specialists outside hospitals (gynecologists: 0.74 (0.69, 0.78); dermatologists: 0.81 (0.78-0.85); pneumologists 0.82 (0.71-0.94); dentists 0.71 (0.68, 0.75)); higher odds of ED visits (OR = 1.25; 95% CI 1.19, 1.31); and no difference in hospital admissions (OR = 1.02; 95% CI 0.97, 1.09). Participants with lower occupational status and income had higher odds of forgoing health care. CONCLUSIONS The perception of those who report having forgone health care for financial reasons is consistent with their lower actual use of community-based ambulatory care (CBAC). While UHI may be necessary to improve healthcare access, it does not address the social factors associated with the population forgoing health care for financial reasons.
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Affiliation(s)
- Anne-Laure Feral-Pierssens
- Population-Based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France. .,Assistance Publique Hôpitaux de Paris, Emergency Department, Georges Pompidou European Hospital, Paris, France. .,Improving Emergency Care - IMPEC federation, Paris, France.
| | - Claire Rives-Lange
- Assistance Publique Hôpitaux de Paris, Nutrition Department, Georges Pompidou European Hospital, Centre Spécialisé Obésité, Paris, France.,Paris University, Paris, France.,INSERM, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), METHODS Team, Paris, France
| | - Joane Matta
- Population-Based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France
| | - Victor G Rodwin
- Département Epidémiologie et Systèmes de Santé, UniSanté, Lausanne, Switzerland.,Wagner School of Public Service, New York University, New York, USA
| | - Marcel Goldberg
- Population-Based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France.,Paris University, Paris, France
| | - Philippe Juvin
- Assistance Publique Hôpitaux de Paris, Emergency Department, Georges Pompidou European Hospital, Paris, France.,Improving Emergency Care - IMPEC federation, Paris, France.,Paris University, Paris, France
| | - Marie Zins
- Population-Based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France.,Paris University, Paris, France
| | - Claire Carette
- Assistance Publique Hôpitaux de Paris, Nutrition Department, Georges Pompidou European Hospital, Centre Spécialisé Obésité, Paris, France.,CIC1418, INSERM, Georges Pompidou European Hospital, Paris, France
| | - Sebastien Czernichow
- Assistance Publique Hôpitaux de Paris, Nutrition Department, Georges Pompidou European Hospital, Centre Spécialisé Obésité, Paris, France.,Paris University, Paris, France.,INSERM, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), METHODS Team, Paris, France
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BENOÎT CYRIL, CORON GAËL. Private Health Insurance in France: Between Europeanization and Collectivization. Milbank Q 2019; 97:1108-1150. [PMID: 31556171 PMCID: PMC6904265 DOI: 10.1111/1468-0009.12420] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Policy Points Private health insurance (PHI) in France has been facing critical changes over the past 30 years. A complementary and voluntary scheme, it has been historically dominated by nonprofit entities. However, the share of for-profit insurance companies in the sector has significantly increased. Nonprofit firms also changed their strategies and mimicked some for-profit behaviors. The present paper argues that this process is a result of the conflict-provoking coevolution of the insurance and health care sectors. Trying to improve the regulation of the insurance industry as whole, two European directives first jeopardized the business model of nonprofit entities. Then, two national reforms designed to improve health coverage significantly increased competition among insurers, notably in the area of corporate-level contracts. Decoupling the insurance and health care sectors has become a major source of policy feedback and unexpected outcomes of reforms affecting the very organization of PHI. CONTEXT In France, private health insurance (PHI) has an exceptionally high level of coverage and accounts for 13.7% of health expenditures. A complementary and voluntary scheme, it has been historically dominated by nonprofit, mutual benefit societies. Over the past 20 years, however, the market share of for-profit insurance companies has increased by 47%. Financialization of the field developed, and competition based on new risk management strategies also increased. The broad aim of this paper is to characterize and to elucidate the causes of this trend. More specifically, we are interested in how and to what extent a series of supranational and national policies contributed to this situation. METHOD Our data come from three sources. We first reviewed documents published by health insurers, government reports, and newspaper articles. We then conducted two semistructured interview campaigns between September 2017 and May 2018. The first mostly covered private and public actors and their involvement in European Union (EU) policymaking (n = 21). The second series of interviews was conducted with another group of actors directly involved at the French level (n = 16). FINDINGS Our findings support preliminary observations. PHI in France, we argue, is indeed facing a development of competition and marketlike instruments. Four major policies (two EU directives and two national reforms) played a significant role in this outcome. Surprisingly, however, it has never been the purpose of legislators and policymakers: while EU directives created a regulatory framework for insurance activities within the Single Market, policies adopted at the national level initially aimed at improving health coverage. We show that it is the interactions and the noncoordination among all of these policies that explain their unexpected outcome. CONCLUSIONS The trend described in this paper is twofold. The first is Europeanization, as PHI in France is increasingly affected by EU legislation. Since this framework tends to favor larger firms and for-profit companies, a reduction in statutory coverage can no longer be considered a quasi-neutral transfer from (publicly owned) social security to nonprofit providers. At the same time, PHI is shifting toward collectivization: as competition increases, complementary health coverage is becoming gradually standardized and based at the corporate level. Together, these changes are likely to reduce freedom of choice and individual welfare, an assumption supported by studies published on the most recent period.
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Affiliation(s)
- CYRIL BENOÎT
- Centre d’études européennes et de politique comparée (CEE)Sciences Po, Centre National de la Recherche Scientifique (CNRS)
| | - GAËL CORON
- Institut de l'Ouest Droit et Europe & Ecole des Hautes Etudes en Santé Publique
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Zeitoun JD, Faron M, de Vaugrigneuse S, Lefèvre JH. Health as an independent predictor of the 2017 French presidential voting behaviour: a cross-sectional analysis. BMC Public Health 2019; 19:1468. [PMID: 31694606 PMCID: PMC6836665 DOI: 10.1186/s12889-019-7861-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 10/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It has been suggested that poor health has influenced vote for Brexit and the US presidential election. No such research has been published regarding the 2017 French presidential election. METHODS We performed a cross-sectional analysis using a comprehensive set of socioeconomic and health indicators, to be compared with voting outcome at the first round of the 2017 French presidential election. The 95 French departments were selected as the unit of analysis. Data were obtained from publicly available sources. The linear model was used for both univariate and multivariate analysis to investigate the relation between voting patterns and predictors. Sensitivity analyses were done using the elastic-net regularisation. RESULTS Emmanuel Macron and Marine Le Pen arrived ahead. When projected on the first factorial plane (~ 60% of the total inertia), Emmanuel Macron and Marine Le Pen tended to be in opposite directions regarding both socioeconomic and health factors. In the respective multivariate analyses of the two candidates, both socio-economic and health variables were significantly associated with voting patterns, with wealthier and healthier departments more likely to vote for Emmanuel Macron, and opposite departments more likely to vote for Marine Le Pen. Mortality (p = 0.03), severe chronic conditions (p = 0.014), and diabetes mellitus (p < 0.0001) were among the strongest predictors of voting pattern for Marine Le Pen. Sensitivity analyses did not substantially change those findings. CONCLUSIONS We found that areas associated with poorer health status were significantly more likely to vote for the far-right candidate at the French presidential election, even after adjustment on socioeconomic criteria.
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Affiliation(s)
- Jean-David Zeitoun
- Centre d'Epidémiologie Clinique, Hôtel Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. .,Department of Gastroenterology and Nutrition, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France. .,Department of Proctology, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France.
| | - Matthieu Faron
- Departments of Surgical Oncology and Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France.,INSERM U1018 CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | | | - Jérémie H Lefèvre
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Sorbonne Université, F-75012, Paris, France.,INSERM, UMRS 938 - Centre de Recherche Saint-Antoine, Equipe "Instabilité des Microsatellites et Cancers", Equipe labellisée par la Ligue Nationale contre le Cancer, F-75012, Paris, France
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31
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Besle S, Sarradon-Eck A. Choisir le risque : l’autonomie du malade en situation d’échec thérapeutique. ANTHROPOLOGIE ET SANTÉ 2019. [DOI: 10.4000/anthropologiesante.4817] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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32
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Fiorentino M, Suzan-Monti M, Vilotitch A, Sagaon-Teyssier L, Dray-Spira R, Lert F, Spire B. Renunciation of health care by people living with HIV in France is still associated with discrimination in health-care services and social insecurity - results from the ANRS-VESPA2 survey. Antivir Ther 2019; 23:443-450. [PMID: 29360097 DOI: 10.3851/imp3220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study aimed to estimate the frequency of renunciation of health care among people living with HIV (PLHIV) in France, including health care unrelated to HIV, and to characterize associated socioeconomic and psychosocial risk factors. METHODS The cross-sectional ANRS-VESPA2 survey was conducted on adult PLHIV attending French hospitals in 2011. Correlates of health-care renunciation in the 12 months before the survey were assessed through logistic modelling. RESULTS Among the 3,020 PLHIV included in the sample, 17% declared health-care renunciation during the preceding year and 42% had a high level of social insecurity. During the previous 2 years, 8% and 11%, respectively, were discriminated against by medical staff and family. In multivariate analysis, positive associations were found between health-care renunciation and a high level of social insecurity (adjusted odds ratio [95% CI] 3.44 [2.54, 4.65]; P<0.001), having children (1.52 [1.10, 2.10]; P=0.01), smoking tobacco (1.50 [1.13, 1.98]; P=0.01), discrimination by medical staff (1.53 [1.22, 2.29]; P=0.04) or family (2.48 [1.75, 3.52]; P<0.001), major depressive episodes (1.46 [1.02, 2.09]; P=0.04), past or current drug injection (1.54 [1.03, 2.30]; P=0.04), and younger age (0.98 [0.97, 1.00]; P=0.03). Health-care renunciation was also negatively associated with HIV diagnosis after 1996 (1996-2002: 0.64 [0.46, 0.90]; P=0.01; ≥2003: 0.56 [0.40, 0.77]; P=0.001). CONCLUSIONS In spite of universal health insurance in France, barrier- and refusal-renunciation of health care by PLHIV remain frequent. Poor psychosocial outcomes and discrimination by families and health-care providers compound the negative effect of social insecurity on health-care seeking in this population. To ensure optimal medical care, strategies are needed to prevent discrimination against PLHIV in health-care services. Special attention must be provided to patients experiencing social insecurity.
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Affiliation(s)
- Marion Fiorentino
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Marie Suzan-Monti
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Antoine Vilotitch
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Luis Sagaon-Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Rosemary Dray-Spira
- INSERM, UMR S1136, Pierre Louis Institute of Epidemiology and Public Health, Team Research in Social Epidemiology, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR_S1136, Pierre Louis Institute of Epidemiology and Public Health, Team Research in Social Epidemiology, Paris, France
| | - France Lert
- Centre de recherche en épidémiologie et santé des populations, Inserm U1018, Villejuif, France
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
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Vignier N, Dray Spira R, Pannetier J, Ravalihasy A, Gosselin A, Lert F, Lydie N, Bouchaud O, Desgrees Du Lou A, Chauvin P. Refusal to provide healthcare to sub-Saharan migrants in France: a comparison according to their HIV and HBV status. Eur J Public Health 2019; 28:904-910. [PMID: 29982518 DOI: 10.1093/eurpub/cky118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background In this study, we aim to measure and compare the frequency of reported denial of care in sub-Saharan African migrants living in the Paris area, according to their HIV and HBV status and social and migration characteristics. Methods The ANRS-PARCOURS study is a life-event survey conducted in 2012-13 in healthcare facilities in the Paris area, among three groups of sub-Saharan migrants recruited in primary care centres (N = 760; reference group), in dedicated centres for HIV care (N = 922; HIV group) and in centres for chronic hepatitis B care (N = 777; CHB group). Characteristics associated with refusal of care since arrival in France were identified using a logistic regression model. Results Compared to the reference group (6%, P < 0.001), the reported refusal of care was twice as high in the HIV group (12%) and the CHB group (10%). In the multivariate analysis, men and women living with HIV were at greater risk of being denied care (aOR = 2.20[1.14-4.25] and 2.24[1.25-4.01]). Women covered by the specific health insurance (HI) for precarious or undocumented migrants were also at higher risk (aOR = 2.07[1.10-3.89] and 2.69[1.18-6.10], respectively). The risk was also increased in men who remained for at least one year without permit of residence or without HI and among those who were threatened in their country. Conclusion Refusals to provide healthcare are frequent and deleterious situations especially for migrants living with HIV. Health decision makers, public insurance bodies and health professional councils must address this issue to improve equity in the healthcare system.
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Affiliation(s)
- Nicolas Vignier
- Department of Social Epidemiology, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Sorbonne Université, Paris, France.,Department of Infectious and Tropical Diseases, Groupe hospitalier Sud Ile-de-France, Sorbonne Université, Melun, France
| | - Rosemary Dray Spira
- Department of Social Epidemiology, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Sorbonne Université, Paris, France
| | - Julie Pannetier
- Santé, vulnérabilité et relations de genre (Sagesud), Sorbonne Paris Cités, IRD, CEPED, ERL INSERM 1244 SAGESUD, Université Paris Descartes, Paris, France
| | - Andrainolo Ravalihasy
- Santé, vulnérabilité et relations de genre (Sagesud), Sorbonne Paris Cités, IRD, CEPED, ERL INSERM 1244 SAGESUD, Université Paris Descartes, Paris, France
| | - Anne Gosselin
- Santé, vulnérabilité et relations de genre (Sagesud), Sorbonne Paris Cités, IRD, CEPED, ERL INSERM 1244 SAGESUD, Université Paris Descartes, Paris, France
| | - France Lert
- Center for Research in Epidemiology and Population Health (CESP-U 1018), INSERM, Université Paris Sud, Villejuif, France
| | - Nathalie Lydie
- Direction de la prévention et de la promotion de la santé-Unité Santé sexuelle, Santé Publique France, French National Agency of Public Health, Saint-Maurice, France
| | - Olivier Bouchaud
- Department of Infectious and Tropical diseases, and Laboratoire Educations et Pratiques de Santé (LEPS EA 3412), Paris 13 University, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Bobigny, France
| | - Annabel Desgrees Du Lou
- Santé, vulnérabilité et relations de genre (Sagesud), Sorbonne Paris Cités, IRD, CEPED, ERL INSERM 1244 SAGESUD, Université Paris Descartes, Paris, France
| | - Pierre Chauvin
- Department of Social Epidemiology, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Sorbonne Université, Paris, France
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Tran VT, Riveros C, Péan C, Czarnobroda A, Ravaud P. Patients' perspective on how to improve the care of people with chronic conditions in France: a citizen science study within the ComPaRe e-cohort. BMJ Qual Saf 2019; 28:875-886. [PMID: 31015376 PMCID: PMC6860767 DOI: 10.1136/bmjqs-2018-008593] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 03/19/2019] [Accepted: 03/30/2019] [Indexed: 12/28/2022]
Abstract
Background This study aimed to involve patients with chronic conditions in generating ideas for improving their care. Methods We performed a citizen science study. Participants were adult patients with chronic conditions recruited in Community of Patients for Research ‘ComPaRe,’ a French e-cohort of patients with chronic conditions. Participants generated ideas to improve their care in answer to the open-ended question, ‘If you had a magic wand, what would you change in your healthcare?’ Three researchers and two patients independently extracted ideas from open-ended answers by using thematic analysis. Ideas were grouped into areas for improvement at the consultation, hospital/clinic and health system levels. Findings were validated and enriched by a second sample of participants recruited in ComPaRe. Results Between May 2017 and April 2018, a total of 1636 patients provided 3613 ideas to improve consultations (1701 ideas related to 58 areas for improvement), hospitals/clinics (928 ideas related to 41 areas for improvement) and the health system (984 ideas related to 48 areas for improvement). At the consultation level, most ideas were related to improving physician–patient discussions, informing patients about their own care, and adapting treatment to patient preferences and context. At the hospital/clinic level, most ideas aimed at improving the coordination and collaboration in care. At the health system level, most ideas were related to decreasing the administrative burden imposed on patients, improving access to care and reducing the costs of care. Conclusion Patients have many ideas to improve their care, from the content of consultations to the organisation of hospitals. Our study provides the proof of concept for a method to leverage patients’ practical knowledge of the care system to improve it.
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Affiliation(s)
- Viet-Thi Tran
- METHODS Team, Centre de Recherche Epidémiologie et Statistique Sorbonne Paris Cité (CRESS UMR 1153), INSERM, Paris, Île-de-France, France .,Centre d'Epidémiologie Clinique - Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Carolina Riveros
- Centre d'Epidémiologie Clinique - Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | - Philippe Ravaud
- METHODS Team, Centre de Recherche Epidémiologie et Statistique Sorbonne Paris Cité (CRESS UMR 1153), INSERM, Paris, Île-de-France, France.,Centre d'Epidémiologie Clinique - Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
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Santilli C. Medical Care, Screening and Regularization of Sub-Saharan Irregular Migrants Affected by Hepatitis B in France and Italy. J Immigr Minor Health 2019; 20:668-673. [PMID: 28425000 DOI: 10.1007/s10903-017-0585-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Both in France and in Italy hepatitis B is present mostly among the migrant population coming from sub-Saharan Africa and mainly among those migrants having a poor socio-economic background. This article is aimed at assaying the impact of public policies adopted by France and Italy for migrants' health on the treatment of migrants with HBV. The article is based on semi-structured interviews conducted with 30 immigrant adults taken into care by two associations dealing with medical, psychological and social issues of immigrants applying for a residence permit, mainly asylum seekers. The results of this study bring to light specific difficulties relating to national contexts, to the type of HBV (inactive or active) and to the administrative situation of the migrants. In France irregular migrants are screened in humanitarian associations. In Italy the screening is done in public hospitals. In both countries, only migrants suffering from chronic hepatitis B obtain a residence permit for medical reasons. More migrants in Italy than in France abandon HBV treatment. This study describes how specific national immigration and health policies impact in a different way the therapeutic and social path of migrants suffering from hepatitis B. The analysis provides useful material for the development of strategies to prevent and control hepatitis B among the migrant population. It also shows how social determinants affect migrants' health more than values or cultural factors do.
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Affiliation(s)
- Cecilia Santilli
- INSERM, UMR_S 912, « Sciences Economiques & Sociales de la Santé et Traitement de l'Information Médicale » (SESSTIM), 13385, Marseille, France. .,Aix Marseille Université, UMR_S 912, IRD, Marseille, 13385, Marseille, France. .,Dipartimento Storia, Culture, Religioni, Università di Roma La Sapienza, Rome, Italy. .,, 9 rue de la Tour, 75016, Paris, France.
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Ranabhat CL, Kim CB, Singh A, Acharya D, Pathak K, Sharma B, Mishra SR. Challenges and opportunities towards the road of universal health coverage (UHC) in Nepal: a systematic review. Arch Public Health 2019; 77:5. [PMID: 30740223 PMCID: PMC6360747 DOI: 10.1186/s13690-019-0331-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 01/15/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Universal health coverage (UHC) assures all types of health service and protects all citizens financially in any conditions due to illness. Globally, the UN sustainable development goal (SDG) provides high priority for UHC as a health related goal. The National health system of Nepal has prioritized in similar way. The aim of this study is to explore the challenges and opportunities on the road to UHC in Nepal. METHOD We used varieties of search terminologies with popular search engines like PubMed, Google, Google Scholar, etc. to identify studies regarding Nepal's progress towards UHC. Reports of original studies, policies, guidelines and government manuals were taken from the web pages of Ministry of Health and its department/division. Searches were designed to identify the status of service coverage on UHC, financial protection on health particularly, health insurance coverage with its legal status. Other associated factors related to UHC were also explored and presented in Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart. RESULTS We found 14 studies that were related to legal assurance, risk pulling and financing of health service, 11 studies associated to UHC service coverage status and, 7 articles linked to government stewardship, health system and governance on health care. Constitutional provision, global support, progress on the health insurance act, decentralization of health service to the grass root level, positive trends of increasing service coverage are seen as opportunities. However, existing volunteer types of health insurance, misleading role of trade unions and high proportion of population outside the country are main challenges. The political commitment under the changing political context, a sense of national priority and international support were identified as the facilitating factors towards UHC. CONCLUSION To achieve UHC, service and population coverage of health services has to be expanded along with financial protection for marginalized communities. Government stewardship, support of stakeholders and fair contribution and distribution of resources by appropriate health financing modality can speed up the path of UHC in Nepal.
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Affiliation(s)
- Chhabi Lal Ranabhat
- Manmohan Memorial Institute of Health Science, Solteemod, Kathmandu -17, POB 44300 Nepal
- Institute for Poverty Alleviation and International Development, Yonsei University, Ilsanro, 162 Wonju Si, Gangwon do Republic of Korea
| | - Chun-Bae Kim
- Institute for Poverty Alleviation and International Development, Yonsei University, Ilsanro, 162 Wonju Si, Gangwon do Republic of Korea
- Institute for Poverty Alleviation and International Development (IPAID) at Yonsei University 1, Yonseidae-gil, Wonju Si, Gangwon-do South Korea
| | - Ajanta Singh
- Institute of Medicine, Maharajgunj Nursing Campus, Kathmandu, Nepal
| | - Devaraj Acharya
- Central Campus, Tribhuwan University, Kritipur, Kathmandu, Nepal
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Vignier N, Desgrees Du Lou A, Pannetier J, Ravalihasy A, Gosselin A, Lert F, Lydie N, Bouchaud O, Dray Spira R, Chauvin P. Social and structural factors and engagement in HIV care of sub-Saharan African migrants diagnosed with HIV in the Paris region. AIDS Care 2019; 31:897-907. [PMID: 30709323 DOI: 10.1080/09540121.2019.1576842] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Migrants from sub-Saharan Africa (SSA) are often diagnosed at an advanced stage of HIV, and many of them have harsh living conditions. We aimed to evaluate the entry into care after HIV diagnosis and examine the related social determinants. The ANRS PARCOURS study is a life-event survey conducted in 2012-2013 in the Paris region among. Time between HIV diagnosis of SSA migrants living diagnosed HIV positive in France and HIV care and the determinants was assessed yearly by using mixed-effects logistic regression models. Among a total of 792 participants, 94.2% engaged in HIV care within the year of HIV diagnosis, 4.3% in the following year and 2.5% beyond the second year after diagnosis. The participants were more likely to engage in HIV care during years when they were effectively covered by health insurance and if the HIV test was carried out at the initiative of the doctor. Immigration for economic reasons or owing to threats in his/her country of origin was associated with delayed engagement in HIV care. Additionally, 4.3% of treated participants discontinued HIV care at least once at the time of the survey and more often if diagnosed at an advanced HIV disease stage and financially dependent.
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Affiliation(s)
- Nicolas Vignier
- a Department of Social Epidemiology , INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP) Paris , France.,b Department of Infectious and Tropical Diseases , Groupe hospitalier Sud Ile-de-France , Melun , France
| | | | - Julie Pannetier
- c IRD, INSERM , Université Paris Descartes, CEPED, SAGESUD team , Paris , France
| | | | - Anne Gosselin
- c IRD, INSERM , Université Paris Descartes, CEPED, SAGESUD team , Paris , France
| | - France Lert
- d INSERM , Center for Research in Epidemiology and Population Health (CESP-U 1018) , Villejuif , France
| | - Nathalie Lydie
- e Santé Publique France , French National Agency of Public Health , Saint-Maurice , France
| | - Olivier Bouchaud
- f Department of Infectious and Tropical diseases, and Laboratoire Educations et Pratiques de Santé (LEPS EA 3412) , Paris 13 University, Assistance Publique-Hôpitaux de Paris (AP-HP), Avicenne Hospital , Bobigny , France
| | - Rosemary Dray Spira
- a Department of Social Epidemiology , INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP) Paris , France
| | - Pierre Chauvin
- a Department of Social Epidemiology , INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP) Paris , France
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Hone T, Macinko J, Millett C. Revisiting Alma-Ata: what is the role of primary health care in achieving the Sustainable Development Goals? Lancet 2018; 392:1461-1472. [PMID: 30343860 DOI: 10.1016/s0140-6736(18)31829-4] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/26/2018] [Accepted: 08/01/2018] [Indexed: 01/08/2023]
Abstract
The Sustainable Development Goals (SDGs) are now steering the global health and development agendas. Notably, the SDGs contain no mention of primary health care, reflecting the disappointing implementation of the Alma-Ata declaration of 1978 over the past four decades. The draft Astana declaration (Alma-Ata 2·0), released in June, 2018, restates the key principles of primary health care and renews these as driving forces for achieving the SDGs, emphasising universal health coverage. We use accumulating evidence to show that countries that reoriente their health systems towards primary care are better placed to achieve the SDGs than those with hospital-focused systems or low investment in health. We then argue that an even bolder approach, which fully embraces the Alma-Ata vision of primary health care, could deliver substantially greater SDG progress, by addressing the wider determinants of health, promoting equity and social justice throughout society, empowering communities, and being a catalyst for advancing and amplifying universal health coverage and synergies among SDGs.
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Affiliation(s)
- Thomas Hone
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK.
| | - James Macinko
- Department of Community Health Sciences and Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK; Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
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Andrade LF, Rapp T, Sevilla-Dedieu C. Quality of diabetes follow-up care and hospital admissions. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2018; 18:153-167. [PMID: 29098481 DOI: 10.1007/s10754-017-9230-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Diabetes may lead to severe complications. For this reason, disease prevention and improvement of medical follow-up represent major public health issues. The aim of this study was to measure the impact of adherence to French follow-up guidelines on hospitalization of people with diabetes. We used insurance claims data from the years 2010 to 2013 collected for 52,027 people aged over 18, affiliated to a French social security provider and treated for diabetes. We estimated panel data models to explore the association between adherence to guidelines and different measures of hospitalization, controlling for socioeconomic characteristics, diabetes treatment and density of medical supply. The results show that adherence to four guidelines was associated with a significant decrease in hospital admissions, up to approximatively 30% for patients monitored for a complete lipid profile or microalbuminuria during the year. In addition, our analyses confirmed the strong protective effect of income and a significant positive correlation with good supply of hospital care. In conclusion, good adherence to French diabetes guidelines seems to be in line with the prevention of health events, notably complications, that could necessitate hospitalization.
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Affiliation(s)
- L F Andrade
- MGEN Foundation for Public Health, 3 square Max Hymans, 75747, Paris Cedex 15, France
- LIRAES (EA 4470), University of Paris Descartes, 45 rue des Saints-Pères, 75270, Paris Cedex 06, France
| | - T Rapp
- LIRAES (EA 4470), University of Paris Descartes, 45 rue des Saints-Pères, 75270, Paris Cedex 06, France
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Kresge 431 - 677 Huntington Avenue, Boston, MA, 02115, USA
| | - C Sevilla-Dedieu
- MGEN Foundation for Public Health, 3 square Max Hymans, 75747, Paris Cedex 15, France.
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Goldman AL, Woolhandler S, Himmelstein DU, Bor DH, McCormick D. Out-of-Pocket Spending and Premium Contributions After Implementation of the Affordable Care Act. JAMA Intern Med 2018; 178:347-355. [PMID: 29356828 PMCID: PMC5885918 DOI: 10.1001/jamainternmed.2017.8060] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
IMPORTANCE The Affordable Care Act (ACA) was associated with a reduced number of Americans who reported being unable to afford medical care, but changes in actual health spending by households are not known. OBJECTIVES To estimate changes in household spending on health care nationwide after implementation of the ACA. DESIGN, SETTING, AND PARTICIPANTS Population-based data from the Medical Expenditure Panel Survey from January 1, 2012, through December 31, 2015, and multivariable regression were used to examine changes in out-of-pocket spending, premium contributions, and total health spending (out-of-pocket plus premiums) after the ACA's coverage expansions on January 1, 2014. The study population included a nationally representative sample of US adults aged 18 to 64 years (n = 83 431). In addition, changes were assessed in the likelihood of exceeding affordability thresholds for each outcome and spending changes for income subgroups defined under the ACA to determine program eligibility at 138% or less, 139% to 250%, 251% to 400%, and greater than 400% of the federal poverty level (FPL). EXPOSURE Implementation of the ACA's major insurance programs on January 1, 2014. MAIN OUTCOMES AND MEASURES Mean individual-level out-of-pocket spending and premium payments and the percentage of persons experiencing high-burden spending, defined as more than 10% of family income for out-of-pocket expenses, more than 9.5% for premium payments, and more than 19.5% for out-of-pocket plus premium payments. RESULTS In this nationally representative survey of 83 431 adults (weighted frequency, 49.1% men and 50.9% women; median age, 40.3 years; interquartile range, 28.6-52.4 years), ACA implementation was associated with an 11.9% decrease (95% CI, -17.1% to -6.4%; P < .001) in mean out-of-pocket spending in the full sample, a 21.4% decrease (95% CI, -30.1% to -11.5%; P < .001) in the lowest-income group (≤138% of the FPL), an 18.5% decrease (95% CI, -27.0% to -9.0%; P < .001) in the low-income group (139%-250% of the FPL), and a 12.8% decrease (95% CI, -22.1% to -2.4%; P = .02) in the middle-income group (251%-400% of the FPL). Mean premium spending increased in the full sample (12.1%; 95% CI, 1.9%-23.3%) and the higher-income group (22.9%; 95% CI, 5.5%-43.1%). Combined out-of-pocket plus premium spending decreased in the lowest-income group only (-16.0%; 95% CI, -27.6% to -2.6%). The odds of household out-of-pocket spending exceeding 10% of family income decreased in the full sample (odds ratio [OR], 0.80; 95% CI, 0.70-0.90) and in the lowest-income group (OR, 0.80; 95% CI, 0.67-0.97). The odds of high-burden premium spending increased in the middle-income group (OR, 1.28; 95% CI, 1.03-1.59). CONCLUSIONS AND RELEVANCE Implementation of the ACA was associated with reduced out-of-pocket spending, particularly for low-income persons. However, many of these individuals continue to experience high-burden out-of-pocket and premium spending. Repeal or substantial reversal of the ACA would especially harm poor and low-income Americans.
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Affiliation(s)
- Anna L Goldman
- Cambridge Health Alliance, Cambridge, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Steffie Woolhandler
- Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, City University of New York at Hunter College, New York City, New York
| | - David U Himmelstein
- Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, City University of New York at Hunter College, New York City, New York
| | - David H Bor
- Cambridge Health Alliance, Cambridge, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Danny McCormick
- Cambridge Health Alliance, Cambridge, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
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Vignier N, Desgrées du Loû A, Pannetier J, Ravalihasy A, Gosselin A, Lert F, Lydié N, Bouchaud O, Dray Spira R. Access to health insurance coverage among sub-Saharan African migrants living in France: Results of the ANRS-PARCOURS study. PLoS One 2018; 13:e0192916. [PMID: 29447257 PMCID: PMC5814022 DOI: 10.1371/journal.pone.0192916] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 01/20/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Migrants' access to care depends on their health insurance coverage in the host country. We aimed to evaluate in France the dynamic and the determinants of health insurance coverage acquisition among sub-Saharan migrants. METHODS In the PARCOURS life-event retrospective survey conducted in 2012-2013 in health-care facilities in the Paris region, data on health insurance coverage (HIC) each year since arrival in France has been collected among three groups of sub-Saharan migrants recruited in primary care centres (N = 763), centres for HIV care (N = 923) and for chronic hepatitis B care (N = 778). Year to year, the determinants of the acquisition and lapse of HIC were analysed with mixed-effects logistic regression models. RESULTS In the year of arrival, 63.4% of women and 55.3% of men obtained HIC. But three years after arrival, still 14% of women and 19% of men had not obtained HIC. HIC acquisition was accelerated in case of HIV or hepatitis B infection, for migrants arrived after 2000, and for women in case of pregnancy and when they were studying. Conversely, it was slowed down in case of lack of a residency permit and lack of financial resources for men. In addition, women and men without residency permits were more likely to have lost HIC when they had one. CONCLUSION In France, the health insurance system aiming at protecting all, including undocumented migrants, leads to a prompt access to HIC for migrants from sub-Saharan Africa. Nevertheless, this access may be impaired by administrative and social insecurities.
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Affiliation(s)
- Nicolas Vignier
- INSERM, Sorbonne Université, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, Paris, France
- Groupe hospitalier Sud Ile-de-France, Department of Infectious and Tropical Diseases, Melun, France
| | | | - Julie Pannetier
- Sorbonne Paris Cités, IRD, CEPED, ERL INSERM 1244 SAGESUD, Paris, France
| | | | - Anne Gosselin
- Sorbonne Paris Cités, IRD, CEPED, ERL INSERM 1244 SAGESUD, Paris, France
| | - France Lert
- INSERM, Centre for Research in Epidemiology and Population Health (CESP-U 1018), Villejuif, France
| | - Nathalie Lydié
- Santé Publique France, French National Agency of Public Health, Saint-Maurice, France
| | - Olivier Bouchaud
- Paris 13 University, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Infectious and Tropical diseases, and Laboratoire Educations et Pratiques de Santé (LEPS EA 3412), Bobigny, France
| | - Rosemary Dray Spira
- INSERM, Sorbonne Université, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, Paris, France
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Vignier N, Spira RD, Bouchaud O, du Loû AD, Chauvin P. Refusal to provide health care to sub-Saharan African migrants in France. LANCET PUBLIC HEALTH 2018; 3:e12. [DOI: 10.1016/s2468-2667(17)30246-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/18/2017] [Indexed: 10/18/2022]
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Fleury C, Tourette-Turgis C. Une école française du soin ? Analyse de deux cas d’innovation socio-thérapeutique : l’Université des patients et la Chaire de philosophie à l’Hôpital. ACTA ACUST UNITED AC 2018. [DOI: 10.3917/lsdlc.hs07.0183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Cortaredona S, Ventelou B. The extra cost of comorbidity: multiple illnesses and the economic burden of non-communicable diseases. BMC Med 2017; 15:216. [PMID: 29221453 PMCID: PMC5723100 DOI: 10.1186/s12916-017-0978-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/14/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The literature offers competing estimates of disease costs, with each study having its own data and methods. In 2007, the Dutch Center for Public Health Forecasting of the National Institute for Public Health and the Environment provided guidelines that can be used to set up cost-of-illness (COI) studies, emphasising that most COI analyses have trouble accounting for comorbidity in their cost estimations. When a patient has more than one chronic condition, the conditions may interact such that the patient's healthcare costs are greater than the sum of the costs for the individual diseases. The main objective of this work was to estimate the costs of 10 non-communicable diseases when their co-occurrence is acknowledged and properly assessed. METHODS The French Echantillon Généraliste de Bénéficiaires (EGB) database was used to assign all healthcare expenses for a representative sample of the population covered by the National Health Insurance. COIs were estimated in a bottom-up approach, through regressions on individuals' healthcare expenditure. Two-way interactions between the 10 chronic disease variables were included in the expenditure model to account for possible effect modification in the presence of comorbidity(ies). RESULTS The costs of the 10 selected chronic diseases were substantially higher for individuals with comorbidity, demonstrating the pattern of super-additive costs in cases of diseases interaction. For instance, the cost associated with diabetes for people without comorbidity was estimated at 1776 €, whereas this was 2634 € for people with heart disease as a comorbidity. Overall, we detected 41 cases of super-additivity over 45 possible comorbidities. When simulating a preventive action on diabetes, our results showed that significant monetary savings could be achieved not only for diabetes itself, but also for the chronic diseases frequently associated with diabetes. CONCLUSIONS When comorbidity exists and where super-additivity is involved, a given preventive policy leads to greater monetary savings than the costs associated with the single diagnosis, meaning that the returns from the action are generally underestimated.
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Affiliation(s)
- Sébastien Cortaredona
- Aix-Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, 19-21 boulevard Jean Moulin, 13005, Marseille, France. .,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France.
| | - Bruno Ventelou
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France.,Aix-Marseille Univ., CNRS, EHESS, Centrale Marseille, Aix-Marseille School of Economics, Marseille, France
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Boyd A, Bottero J, Carrat F, Gozlan J, Rougier H, Girard PM, Lacombe K. Testing for hepatitis B virus alone does not increase vaccine coverage in non-immunized persons. World J Gastroenterol 2017; 23:7037-7046. [PMID: 29097876 PMCID: PMC5658321 DOI: 10.3748/wjg.v23.i38.7037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/11/2017] [Accepted: 09/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To determine whether hepatitis B virus (HBV)-testing could serve as a gateway to vaccinate non-immunized individuals in a low-prevalent country.
METHODS Non-immunized subjects participating in a multi-center, HBV-testing campaign in Paris, France were identified and contacted via telephone 3-9 mo after testing in order to determine vaccination status. Vaccination coverage was evaluated in per-protocol (for all respondents) and intent-to-treat analysis (assuming all non-responders did not vaccinate).
RESULTS In total, 1215/4924 (24.7%) enrolled subjects with complete HBV serology were identified as non-immunized and eligible for analysis. There were 99/902 successfully contacted subjects who had initiated HBV vaccination after screening: per-protocol, 11.0% (95%CI: 9.0-13.2); intent-to-treat, 8.2% (95%CI: 6.7-9.8). In multivariable analysis, vaccination was more likely to be initiated in individuals originating from moderate or high HBV-endemic countries (P < 0.001), patients with limited healthcare coverage (P = 0.01) and men who have sex with men (P = 0.02). When asked about the reasons for not initiating HBV vaccination, the most frequent response was “will be vaccinated later” (33.4%), followed by “did not want to vaccinate” (29.8%), and “vaccination was not proposed by the physician” (21.5%). Sub-group analysis indicated a stark contrast in vaccination coverage across centers, ranging from 0%-56%.
CONCLUSION HBV-vaccination after HBV screening was very low in this study, which appeared largely attributed to physician-patient motivation towards vaccination. Increased vaccination coverage might be achieved by emphasizing its need at the organizational level.
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Affiliation(s)
- Anders Boyd
- Institute Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), INSERM, Sorbonne Universités, F-75012 Paris, France
| | - Julie Bottero
- Institute Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), INSERM, Sorbonne Universités, F-75012 Paris, France
- Service de maladies infectieuses, Hôpital Saint-Antoine, AP-HP, F-75012 Paris, France
| | - Fabrice Carrat
- Institute Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), INSERM, Sorbonne Universités, F-75012 Paris, France
- Département de santé publique, Hôpital Saint-Antoine, AP-HP, F-75012 Paris, France
| | - Joël Gozlan
- Laboratoire de Virologie, Hôpital Saint-Antoine, AP-HP, F-75012 Paris, France
- INSERM, UMR_S1135 CIMI, Paris F-75013, France
| | - Hayette Rougier
- Service de maladies infectieuses, Hôpital Saint-Antoine, AP-HP, F-75012 Paris, France
| | - Pierre-Marie Girard
- Institute Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), INSERM, Sorbonne Universités, F-75012 Paris, France
- Service de maladies infectieuses, Hôpital Saint-Antoine, AP-HP, F-75012 Paris, France
| | - Karine Lacombe
- Institute Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), INSERM, Sorbonne Universités, F-75012 Paris, France
- Service de maladies infectieuses, Hôpital Saint-Antoine, AP-HP, F-75012 Paris, France
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Value of a national administrative database to guide public decisions: From the système national d’information interrégimes de l’Assurance Maladie (SNIIRAM) to the système national des données de santé (SNDS) in France. Rev Epidemiol Sante Publique 2017; 65 Suppl 4:S149-S167. [DOI: 10.1016/j.respe.2017.05.004] [Citation(s) in RCA: 337] [Impact Index Per Article: 48.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 05/18/2017] [Accepted: 05/18/2017] [Indexed: 12/11/2022] Open
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Lefeuvre D, Rudant J, Foulon S, Alla F, Weill A. Healthcare expenditure of multiple sclerosis patients in 2013: A nationwide study based on French health administrative databases. Mult Scler J Exp Transl Clin 2017; 3:2055217317730421. [PMID: 28932411 PMCID: PMC5600306 DOI: 10.1177/2055217317730421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 08/09/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Little is known about expenditure items of multiple sclerosis (MS) patients over recent years in France. OBJECTIVE To describe healthcare expenditure among MS patients and identify the main expenditure drivers. METHODS All healthcare expenditure reimbursed by French National Health Insurance to MS patients in 2013 was described on the basis of nationwide health administrative databases (SNIIRAM/PMSI). Expenditure was described globally and according to age and sex. RESULTS The average expenditure among the 90,288 MS patients included was €11,900 per patient. Pharmacy and hospitalisation accounted for 47% and 23% of healthcare expenditure, respectively (38% and 22% of MS patients were treated with disease-modifying therapies and hospitalised overnight or longer, respectively). Average expenditure did not differ according to age. However, pharmacy expenditure decreased with age (from 71% between the ages of 20 and 29 years to 18% between the ages of 70 and 79 years), whereas hospitalisation expenditure increased with age (from 15% to 35%). Paramedical fees accounted for 2% of expenditure between the ages of 20 and 29 years and 24% between the ages of 70 and 79 years. CONCLUSION Overall, pharmacy expenditure was the main expenditure item, which decreased with increasing age, while hospitalisation and paramedical expenditure increased with increasing age.
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Affiliation(s)
- Delphine Lefeuvre
- Direction de la stratégie, des études et des statistiques, French National Health Insurance (Caisse Nationale de l'Assurance Maladie des Travailleurs Salariés), France
| | - Jérémie Rudant
- Direction de la stratégie, des études et des statistiques, French National Health Insurance (Caisse Nationale de l'Assurance Maladie des Travailleurs Salariés), France
| | - Stéphanie Foulon
- Direction de la stratégie, des études et des statistiques, French National Health Insurance (Caisse Nationale de l'Assurance Maladie des Travailleurs Salariés), France
| | - François Alla
- Caisse Nationale de l'Assurance Maladie des Travailleurs Salariés), France
| | - Alain Weill
- Direction de la stratégie, des études et des statistiques, French National Health Insurance (Caisse Nationale de l'Assurance Maladie des Travailleurs Salariés), France
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Feral-Pierssens AL, Jannot AS. Knowledge of medical students on National Health Care System: A French multicentric survey. Rev Epidemiol Sante Publique 2017; 65:331-336. [DOI: 10.1016/j.respe.2017.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 05/08/2017] [Accepted: 05/17/2017] [Indexed: 12/01/2022] Open
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Kantor E, Guglielminotti J, Azria E, Luton D, Laurent M, Oury JF, Mahieu-Caputo D, Ravaud P, Estellat C. Socioeconomic Deprivation and Utilization of Anesthetic Care During Pregnancy and Delivery. Anesth Analg 2017; 125:925-933. [DOI: 10.1213/ane.0000000000002275] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Le Vigouroux A, Marcheix C, Autès E. Gouvernance des politiques publiques favorables à la santé : l’expérience menée en Poitou-Charentes, France. Glob Health Promot 2017. [DOI: 10.1177/1757975917701689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
En 2011, la Cour des Comptes dresse un constat sévère des dysfonctionnements des politiques publiques de prévention en santé, faiblement dotées et fragmentées, alors qu’en France les ressources sont essentiellement orientées vers le système hospitalier « curatif ». L’Agence Régionale de Santé (ARS) Poitou-Charentes, compétente en matière de prévention à l’échelle régionale, a décidé en 2012 d’instaurer, via des plateformes de prévention, des politiques publiques construites avec les opérateurs de la promotion de la santé et de la prévention et les acteurs des territoires, afin de promouvoir une action publique pertinente, cohérente et efficace, correspondant aux champs d’interventions prioritaires. Une dynamique partenariale et un début de cohérence systémique émergent autour d’objectifs prioritaires visant une résolution de problèmes de santé publique. Le bilan de l’expérience reste mitigé au regard de différentes faiblesses du dispositif, de la fusion des régions et des ARS di Aquitaine Limousin Poitou-Charentes au 1er janvier 2016.
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Affiliation(s)
- Alain Le Vigouroux
- Agence régionale de santé Nouvelle Aquitaine, Délégation départementale de la Charente-Maritime, La Rochelle, France
| | - Cécile Marcheix
- Agence régionale de santé Nouvelle Aquitaine, Délégation départementale de la Vienne, Poitiers, France
| | - Erwan Autès
- Agence régionale de santé Nouvelle Aquitaine, Direction de la santé publique, Bordeaux, France. Ecole normale supérieure de Lyon, laboratoire IHRIM (doctorant), Lyon, France
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