Reçoit-on les mêmes soins partout en France ? La question de l’hétérogénéité des pratiques, de leur raison d’être et de leur contrôleBook chapterAlain Paraponaris and Bruno Ventelou, In: Le système de santé français aujourd'hui : enjeux et défis, T Barnay, A.-L. Samson and B. Ventelou (Eds.), 2021-07, pp. 157-176, EP Eska Publishing, 2021
Healthcare consumption after a change in health insurance coverage: a French quasi-natural experimentJournal articleChristine Sevilla-Dedieu, Nathalie Billaudeau and Alain Paraponaris, Health Economics Review, Volume 10, Issue 17, pp. 10, 2020

Compared with the number of studies performed in the United States, few studies have been conducted on the link between health insurance and healthcare consumption in Europe, likely because most European countries have compulsory national health insurance (NHI) or a national health service (NHS). Recently, a major French private insurer, offering voluntary complementary coverage in addition to the compulsory NHI, replaced its single standard package with a range of offers from basic coverage (BC) to extended coverage (EC), providing a quasi-natural experiment to test theoretical assumptions about consumption patterns.

Reimbursement claim data from 85,541 insurees were analysed from 2009 to 2018. Insurees who opted for EC were matched to those still covered by BC with similar characteristics. Difference-in-differences (DiD) models were used to compare both the monetary value and physical quantities of healthcare consumption before and after the change in coverage.

As expected, the DiD models revealed a strongly significant, though transitory (mainly during the first year), increase after the change in coverage for EC insurees, particularly for costly care such as dental prostheses and spectacles. Surprisingly, consumption seemed to precede the change in coverage, suggesting that one possible determinant of opting for more coverage may be previous unplanned expenses.

Both catching-up behaviour and moral hazard are likely to play a role in the observed increase in healthcare consumption.

The positive effect of workplace accommodations on the continued employment of cancer survivors five years after diagnosisJournal articleCaroline Alleaume, Alain Paraponaris, Marc-Karim Bendiane, Patrick Peretti-Watel and Anne-Deborah Bouhnik, Supportive Care in Cancer, Volume 28, Issue 9, pp. 4435-4443, 2020

To address the gap highlighted in the literature on the effect of professional interventions to facilitate continued employment, this study aims to evaluate the effect of workplace accommodations on the continued employment 5 years after a cancer diagnosis.

This study is based on VICAN5, a French survey conducted in 2015-2016 to examine the living conditions of cancer survivors 5 years after diagnosis. Two subsamples, one with and one without workplace accommodations, were matched using a propensity score to control for the individual, professional, and medical characteristics potentially associated with receipt of workplace accommodations.

The study sample was composed of 1514 cancer survivors aged 18-54 and employed as salaried at diagnosis. Among them, 61.2% received workplace accommodations within 5 years after diagnosis: 35.5% received a modified workstation, 41.5% received a modified schedule, and 49.2% received reduced hours. After matching, receipt of workplace accommodations appeared to improve the continued employment rate 5 years after cancer diagnosis from 77.8% to 95.0%.

Receipt of workplace accommodations strongly increases the continued employment of cancer survivors 5 years after diagnosis. More research is needed to better understand the differences in receipt of workplace accommodations along with the related selection effect.

Long-term work outcomes and the efficacy of multidisciplinary rehabilitation programs on labor force participation in cancer patients - a protocol for a longitudinal prospective cohort studyJournal articleHarald K. Engan, Line M. Oldervoll, Gro F. Bertheussen, Martine H. Gaarder, Roy A. Nielsen, Alain Paraponaris, Guro B. Stene, Jon A. Sandmael, Torgrim Tandstad and Steffen Torp, Journal of Public Health Research, Volume 9, Issue 4, pp. 511-516, 2020

Many cancer survivors experience late effects of cancer treatment and therefore struggle to return to work. Norway provides rehabilitation programs to increase labor force participation for cancer survivors after treatment. However, the extent to which such programs affect labor force participation has not been appropriately assessed. This study aims to investigate i) labor force participation, sick leave and disability rates among cancer survivors up to 10 years after being diagnosed with cancer and identify comorbidities contributing to long-term sick leave or disability pensioning; ii) how type of cancer, treatment modalities, employment sectors and financial- and sociodemographic factors may influence labor force participation; iii) how participation in rehabilitation programs among cancer survivor affect the longterm labor force participation, the number of rehospitalizations and incidence of comorbidities.

Design and methods.
Information from four medical, welfare and occupational registries in Norway will be linked to information from 163,279 cancer cases (15.68 years old) registered in the Norwegian Cancer Registry from 2004 to 2016. The registries provide detailed information on disease characteristics, comorbidities, medical and surgical treatments, occupation, national insurance benefits and demographics over a 10-year period following a diagnosis of cancer.

Expected impact of the study for Public Health.
The study will provide important information on how treatment, rehabilitation and sociodemographic factors influence labor force participation among cancer survivors. Greater understanding of work-related risk factors and the influence of rehabilitation on work-participation may encourage informed decisions among cancer patients, healthcare and work professionals and service planners.

Work-Related Outcomes in Self-Employed Cancer Survivors: A European Multi-country StudyJournal articleSteffen Torp, Alain Paraponaris, Elke Van Hoof, Marja-Liisa Lindbohm, Sietske J. Tamminga, Caroline Alleaume, Nick Van Campenhout, Linda Sharp and Angela G. E. M. de Boer, Journal of Occupational Rehabilitation, Volume 29, Issue 2, pp. 361-374, 2019

Purpose To describe: (i) patterns of self-employment and social welfare provisions for self-employed and salaried workers in several European countries; (ii) work-related outcomes after cancer in self-employed people and to compare these with the work-related outcomes of salaried survivors within each sample; and (iii) work-related outcomes for self-employed cancer survivors across countries. Methods Data from 11 samples from seven European countries were included. All samples had cross-sectional survey data on work outcomes in self-employed and salaried cancer survivors who were working at time of diagnosis (n = 22–261 self-employed/101–1871 salaried). The samples included different cancers and assessed different outcomes at different times post-diagnosis. Results Fewer self-employed cancer survivors took time off work due to cancer compared to salaried survivors. More self-employed than salaried survivors worked post-diagnosis in almost all countries. Among those working at the time of survey, self-employed survivors had made a larger reduction in working hours compared to pre-diagnosis, but they still worked more hours per week post-diagnosis than salaried survivors. The self-employed had received less financial compensation when absent from work post-cancer, and more self-employed, than salaried, survivors reported a negative financial change due to the cancer. There were differences between self-employed and salaried survivors in physical job demands, work ability and quality-of-life but the direction and magnitude of the differences differed across countries. Conclusion Despite sample differences, self-employed survivors more often continued working during treatment and had, in general, worse financial outcomes than salaried cancer survivors. Other work-related outcomes differed in different directions across countries.

39th French Health Economists Days : IntroductionJournal articleCarine Franc, Alain Paraponaris and Bruno Ventelou, Revue d'économie politique, Volume 129, Issue 4, pp. 441-445, 2019


Predicting musculoskeletal disorders risk using tree-based ensemble methodsJournal articleAlain Paraponaris, A. Ba, Ewen Gallic, Q. Liance and Pierre Michel, European Journal of Public Health, Volume 29, Issue Supplement_4, 2019

Musculoskeletal disorders (MSD) can cause short-term disorders and permanent disabilities which may all result in serious limitations in ac

The positive effect of workplace accommodations on employment five years after a cancer diagnosisJournal articleCaroline Alleaume, Alain Paraponaris, Marc Karim Bendiane, Patrick Peretti-Watel and Anne-Deborah Bouhnik, European Journal of Public Health, Volume 29, Issue Supplement_4, 2019

Each year, almost 400,000 new individuals are diagnosed with cancer in France and nearly half of them are in the working age. The disease was found to have a negative impact on professional life, especially for the most vulnerable cancer survivors. Literature reviews have pointed out the lack of studies focusing on the evaluation of interventions. In France, workstation layouts are recommended by the French law, but not mandatory to facilitate return to work. The aim of this study was to explore the effect of having a workstation layout after a cancer diagnosis on maintenance in employment five years after diagnosis.

We used the French VICAN survey carried out in 2015/2016 on living conditions five years after a cancer diagnosis. Using propensity score matching, we matched two subsamples (with and without workstation layout) to investigate the effect of workstation layout taking into account the characteristics associated with the access to these arrangements.

Among the 1,514 individuals aged between 18 and 54 at diagnosis and employed in a salaried job at this time, three in five (61.2%) had a workstation layout within the five years following the diagnosis: 35.5% had a position type layout, 41.5% had a schedule layout, and 49.2% had a working time layout. Among those who had a workstation layout, 89.7% were still in employment five years after diagnosis against only 77.8% of those who did not so (p.value<0,001). After matching, having a workstation layout increased maintenance in employment from 77.8% to 95.0% (Average workstation layout effect on the treated of 0.172, 95% CI = [0.114; 0.229]).

Having a workstation layout after a cancer diagnosis strongly increases maintenance in employment of five years cancer survivors. More research is needed to better understand the differences in access to these arrangements and the related
selection effect.

Key messages:
Workstation layout increases maintenance in employment of survivors five years after a cancer diagnosis. Therefore, it should be used more systematically to facilitate work with a chronic disease. Having a workstation layout may constitute a disadvantageous selection bias for more vulnerable workers. It can also lead to discrimination feelings.

Recours aux arrêts-maladie et au temps partiel thérapeutique après un diagnostic de cancerBook chapterCaroline Alleaume, Philippe-Jean Bousquet, Xavier Joutard, 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. 222-242:Ch13, INCa, 2018


Trajectoires professionnelles après un diagnostic de cancerBook chapterCaroline Alleaume, Philippe-Jean Bousquet, Xavier Joutard, 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. 202-220:Ch12, INCa, 2018