Paraponaris

Publications

Situation professionnelle cinq ans après un diagnostic de cancerBook chapterCaroline Alleaume, Philippe-Jean Bousquet, Xavier Joutard, Alain Paraponaris, Patrick Peretti-Watel, Valerie Seror and Patricia Vernay, In: La vie cinq ans après un diagnostic de cancer, MK Ben Diane, AD Bouhnik, J Mancini and P. Peretti-Watel (Eds.), 2018-06, pp. 174-201:Ch11, INCa, 2018

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Évolution des revenus cinq ans après le diagnostic d’un cancerBook chapterCaroline Alleaume, Xavier Joutard, Lionel Lafay, Alain Paraponaris, Patrick Peretti-Watel and Valerie Seror, In: La vie cinq ans après un diagnostic de cancer, MK Ben Diane, AD Bouhnik, J Mancini and P. Peretti-Watel (Eds.), 2018-06, pp. 150-173:Ch10, INCa, 2018
Take the Money and Run? Hypothetical Fee Variations and French GPs’ Labour SupplyJournal articleOlivier Chanel, Alain Paraponaris, Christel Protière and Bruno Ventelou, Revue Économique, Volume 68, Issue 3, pp. 357-377, 2017

This paper analyses how French general practitioners? (GPs) labour supply would respond to changes in their fee per consultation, seeking to determine whether there is a backward-bending curve.?Because French GPs? fees only evolve very slowly and are generally fixed by the National Health Insurance Fund, fee variability is not sufficient to observe changes in labour supply.?Therefore, we designed a contingent valuation survey randomly presenting GPs with three hypothetical fee increases.?Empirical evidence from 1,400 GPs supports the hypothesis of a negative slope in their labour supply curve.?This suggests that increasing fees is not an effective policy to increase the supply of medical services. JEL Codes: C21, I12, J22, J4.

Seasonal influenza vaccine uptake among people with disabilities: A nationwide population study of disparities by type of disability and socioeconomic status in FranceJournal articleAurélie Bocquier, Lisa Fressard, Alain Paraponaris, Bérengère Davin and Pierre Verger, Preventive Medicine, Volume 101, pp. 1-7, 2017

People with disabilities use various preventive health services less frequently than others, notably because of a lower socioeconomic status (SES). We examined variations of seasonal influenza vaccine uptake according to type/severity of disability and SES. We analyzed (in 2016) data from the 2008 French national cross-sectional survey on health and disability (n=12,396 adults living in the community and belonging to target groups for seasonal influenza vaccination). We defined seasonal influenza vaccine uptake during the 2007–2008 season by the self-reporting of a flu shot between September 2007 and March 2008. We built scores of mobility, cognitive, and sensory limitations, and an SES score based on education, occupation, and income. We performed bivariate analyses and then multiple log-binomial regressions. The prevalence of vaccine uptake was 23% in the 18–64 group and 63% in the ≥65 group. In bivariate analyses, it was higher among people in both age groups who had mobility and/or cognitive limitations and in the ≥65 group among those with sensory limitations. In the multiple regression analyses, only the presence of major mobility limitations in the18–64 group remained significant. The probability of vaccine uptake was higher in the highest SES category than in the lowest. Among at-risk groups, people with disabilities were more frequently vaccinated than others, mainly because of their higher levels of morbidity and healthcare use. Socioeconomic inequalities in access to vaccination persist in France. Future research is needed to monitor the trend in vaccine uptake in institutions.

Rates of admission for ambulatory care sensitive conditions in France in 2009-2010: trends, geographic variation, costs, and an international comparisonJournal articleWilliam B. Weeks, Bruno Ventelou and Alain Paraponaris, The European Journal of Health Economics, Volume 17, Issue 4, pp. 453-470, 2016

Background:
Admissions for ambulatory care sensitive conditions (ACSCs) are considered preventable and indicators of poor access to primary care. We wondered whether per-capita rates of admission for ACSCs in France demonstrated geographic variation, were changing, were related to other independent variables, or were comparable to those in other countries; further, we wanted to quantify the resources such admissions consume.

Methods:
We calculated per-capita rates of admission for five categories (chronic, acute, vaccination preventable, alcohol-related, and other) of ACSCs in 94 departments in mainland France in 2009 and 2010, examined measures and causes of geographic variation in those rates, computed the costs of those admissions, and compared rates of admission for ACSCs in France to those in several other countries.

Results:
The highest ACSC admission rates generally occurred in the young and the old, but rates varied across French regions. Over the 2-year period, rates of most categories of ACSCs increased; higher ACSC admission rates were associated with lower incomes and a higher supply of hospital beds. We found that the local supply of general practitioners was inversely associated with rates of chronic and total ACSC admission rates, but that this relationship disappeared if we accounted for patients’ use of general practitioners in neighboring departments. ACSC admissions cost 4.755 billion euros in 2009 and 5.066 billion euros in 2010; they consumed 7.86 and 8.74 million bed days of care, respectively. France had higher rates of ACSC admissions than most other countries examined.

Conclusions:
Because admissions for ACSCs are generally considered a failure of outpatient care, cost French taxpayers substantial monetary and hospital resources, and appear to occur more frequently in France than in other countries, policymakers should prioritize targeted efforts to reduce them.

Transitions in the labor market after cancer: a comparison of self-employed workers and salaried staffJournal articleAurélia Tison, Luis Sagaon-Teyssier, Caroline Sansonetti, Jean-François Blatier, Alain Paraponaris and VICAN 2 Group, Supportive Care in Cancer, Volume 24, Issue 12, pp. 4879-4886, 2016

The aim of this study was to investigate whether the labor market mobility of a population of cancer survivors 2 years after diagnosis differed compared to the French general population by focusing on

Pas de prix mais un coût ? Évaluation contingente de l'aide informelle apportée aux personnes âgées en perte d'autonomieJournal articleBérengère Davin, Alain Paraponaris and Christel Protière, Économie et Statistique, Volume 475, Issue 1, pp. 51-69, 2015

Le vieillissement de la population confronte les pays qu'il concerne à certains défis, notamment au regard des soins de long-terme. Prendre en charge une personne âgée en perte d'autonomie génère en effet à la fois des coûts publics et privés qui se chiffrent en milliards d'euros chaque année. L'objectif de cette analyse est d'étudier les déterminants du consentement à payer (CAP) des aidants informels pour l'aide qu'ils apportent aux personnes âgées de 75 ans et plus vivant à domicile, en utilisant la méthode de l'évaluation contingente. Les données utilisées proviennent de l'enquête nationale Handicap-Santé Aidants informels (HSA) de 2008. On y trouve des questions sur le montant que les aidants seraient prêts à payer pour être déchargés d'une heure d'aide. Un modèle en deux étapes à la Heckman est construit afin d'analyser à la fois les facteurs associés aux montants déclarés de disposition à payer, et les raisons pour lesquelles certains aidants n'ont pas voulu donner de valeur (répondants protestataires). D'après les résultats, des caractéristiques telles que la distance entre lieux de vie de l'aidé et de l'aidant ou encore la dégradation de la santé mentale de ce dernier expriment le besoin de reconnaissance des aidants informels à travers les valeurs déclarées qui leur sont associées, ainsi que leur besoin de répit, dû au fardeau qu'ils supportent parfois depuis plusieurs années. Le contexte socioéconomique joue aussi un rôle important : plus le revenu de l'aidant et celui de la personne aidée sont élevés, plus le montant du CAP est élevé. Ces éléments peuvent être utiles aux politiques publiques en charge de développer des mesures visant tout à la fois à promouvoir l'aide informelle apportée aux personnes âgées et à soulager ceux qui l'apportent.

Characteristics and patterns of elective admissions to for-profit and not-for-profit hospitals in France in 2009 and 2010Journal articleWilliam B. Weeks, Marie Jardin and Alain Paraponaris, Social Science & Medicine, Volume 133, Issue C, pp. 53-58, 2015

In the mid 2000s, in an effort to increase competition among hospitals in France – and thereby reduce hospital care costs – policymakers implemented a prospective payment system and created incentives to promote use of for-profit hospitals. But such policies might incentivize ‘upcoding’ to higher-reimbursed procedures or overuse of preference-sensitive elective procedures, either of which would offset anticipated cost savings. To explore either possibility, we examined the relative use and costs of admissions for ten common preference-sensitive elective surgical procedures to French not-for profit and for-profit sector hospitals in 2009 and 2010. For each admission type, we compared sector-specific hospitalization characteristics and mean per-admission reimbursement and sector-specific relative rates of lower- and higher-reimbursed procedures. We found that, despite having substantially fewer beds, for-profit hospitals captured a large portion of market for these procedures; further, for-profit admissions were shorter and less expensive, even after adjustment for patient demographics, hospital characteristics, and patterns of admission to different reimbursement categories. While French for-profit hospitals appear to provide more efficient care, we found coding inconsistencies across for-profit and not-for-profit hospitals that may suggest supplier-induced demand and upcoding in for-profit hospitals. Future work should examine sector-specific changes in relative use and billing practices of for elective surgeries, the degree to which these elective surgeries are justified in either sector, and whether outcomes differ according to sector used.

Economics of the Iceberg: Informal Care Provided to French Elderly with DementiaJournal articleAlain Paraponaris and Bérengère Davin, Value in Health, Volume 18, Issue 4, pp. 368-375, 2015

OBJECTIVES:

Dementia has a substantial effect on patients and their relatives, who have to cope with medical, social, and economic changes. In France, most elderly people with dementia live in the community and receive informal care, which has not been well characterized.
METHODS:

Using a sample of 4680 people aged 75 years and older collected in 2008 through a national comprehensive survey on health and disability, we compared the economic value of the care received by 513 elderly people with dementia to that received by a propensity score- matched set of older people without dementia.
RESULTS:

More than 85% of elderly people with dementia receive informal care; the estimation of its economic value ranges from €4.9 billion (proxy good method) to €6.7 billion (opportunity cost method) per year.

CONCLUSIONS:
The informal care provided to people with dementia has substantial annual costs; further work should be done to examine the social and economic roles foregone as a result of this care.

Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Les médecins généralistes face au paiement à la performance et à la coopération avec les infirmiersJournal articleSophie Massin, Alain Paraponaris, Marion Bernhard, Pierre Verger, Marie Cavillon, Fanny Mikol and Bruno Ventelou, DREES : Etudes et Résultats, Issue 873, pp. 8, 2014

Les conditions d’exercice de la médecine générale connaissent des évolutions importantes. Le paiement à la performance, généralisé depuis 2012, et la coopération avec les infirmiers, pratique encore à un stade essentiellement expérimental, sont deux dispositifs emblématiques.
La quasi-totalité des médecins interrogés à la fin 2012 dans le cadre du panel de médecins généralistes de ville déclarent avoir adhéré à la Rémunération sur objectifs de santé publique mise en place par l’Assurance maladie en janvier 2012, et 80 % d’entre eux pensent pouvoir en remplir la majorité des objectifs. En revanche, ils sous-estiment nettement la rémunération qu’ils pourraient percevoir grâce à ce dispositif.
Un tiers d’entre eux se déclarent favorables à des coopérations avec un infirmier sur une ou plusieurs tâches. Cependant, ce résultat est très sensible au mode de financement d’un tel dispositif : la coopération est nettement plus acceptée (dans les deux tiers des cas) dans un scénario où l’auxiliaire médical serait entièrement rémunéré par un forfait extérieur. Les tâches qui relèvent des compétences réglementaires du médecin telles que les prescriptions seraient moins volontiers déléguées à un infirmier, contrairement aux actes d’éducation thérapeutique ou de surveillance de la tension artérielle