Cooperation between general practitioners (GPs) and other healthcare professionals appears to help reduce the risk of polypharmacy-related adverse events in patients with multimorbidity.
To investigate GPs profiles according to their opinions and attitudes about interprofessional cooperation and to study the association between these profiles and GPs’ characteristics.
Between May and July 2016, we conducted a cross-sectional survey of a panel of French GPs about their management of patients with multimorbidity and polypharmacy, focussing on their opinions on the roles of healthcare professionals and interprofessional cooperation. We used agglomerative hierarchical cluster analysis to identify GPs profiles, then multivariable logistic regression models to study their associations with the characteristics of these doctors.
1183 GPs responded to the questionnaire. We identified four profiles of GPs according to their declared attitudes towards cooperation: GPs in the ‘very favourable’ profile (14%) were willing to cooperate with various health professionals, including the delegation of some prescribing tasks to pharmacists; GPs in the ‘moderately favourable’ profile (47%) had favourable views on the roles of health professionals, with the exception for this specific delegation of the task; GPs from the ‘selectively favourable’ profile (27%) tended to work only with doctors; GPs from the ‘non-cooperative’ profile (12%) did not seem to be interested in cooperation. Some profiles were associated with GPs’ ages or participation in continuing medical education.
Our study highlights disparities between GPs regarding cooperation with other professionals caring for their patients and suggests ways to improve cooperation.
Reducing the mortality burden associated with urban air pollution constitutes a public health priority, and evidence of unequal exposure and susceptibility across population subgroups is growing. Many European countries have implemented low emission zones (LEZs) in densely populated city centers. Although LEZs decrease air pollution exposure and health impacts, evidence is lacking on their impact across neighborhoods and socio-economic groups.
The aim of this study was to evaluate the most equitable approach to implementing the second phase of the LEZ in Paris, France. We also present a literature review of the studies evaluating the benefits associated with LEZs in Europe.
A health impact assessment (HIA) was conducted to quantify changes in air pollution exposure and expected health benefits by socioeconomic group and neighborhood related to four hypothetical scenarios for the second phase of the LEZ based on French Deprivation Index scores. The study focused on NO2 and PM2.5 as air pollutants and evaluated the impact of the LEZ on the inequitable burden of childhood asthma and all-cause premature adult mortality. We also conducted an economic evaluation associated with the LEZ benefits on prevented deaths and asthma cases.
The scenario with the largest LEZ perimeter and the most stringent vehicle standards prevented the highest number of cases and produced the most equitable distribution of health benefits, especially childhood asthma. It is expected that 810 deaths and 3200 cases of asthma could be prevented from the LEZ extension in this scenario. These results were distributed heterogeneously across three socioeconomic (SES) groups, most noticeably with asthma cases as 230, 180, and 210 cases were avoided per 100,000 inhabitants in high, medium, and low SES groups, respectively. We found substantial economic benefits associated with LEZ, with estimates ranging from €0.76 billion to €2.36 billion for prevented deaths. The benefits associated with asthma reduction ranged from €2.3 million to €8.3 million.
Conducting HIAs with a focus on equity will further inform policy makers of the impact of LEZ models on air pollution, health, and environmental justice. Developing these systematic methods and applying them to future LEZs and other air pollution policies will increase their effectiveness to reduce the burden of ambient air pollution on society and the environment.
Through a series of experiments, this paper tests the relative efficiency of persuasion and commitment schemes to increase and sustain contribution levels in a Voluntary Contribution Game. The design allows us to compare a baseline consisting of a repeated public good game to four treatments of the same game in which we successively introduce a persuasion message, commitment devices, and communication between subjects. Our results suggest that these non-monetary procedures significantly increase cooperation and reduce the decay of contributions across periods.
Epistemic injustices are increasingly decried in global health. This study aims to investigate whether the source of knowledge influences the perception of that knowledge and the willingness to use it in francophone African health policy-making context.
The study followed a randomized experimental design in which participants were randomly assigned to one of seven policy briefs that were designed with the same scientific content but with different organizations presented as authors. Each organization was representative of financial, scientific or moral authority. For each type of authority, two organizations were proposed: one North American or European, and the other African.
The initial models showed that there was no significant association between the type of authority or the location of the authoring organization and the two outcomes (perceived quality and reported instrumental use). Stratified analyses highlighted that policy briefs signed by the African donor organization (financial authority) were perceived to be of higher quality than policy briefs signed by the North American/European donor organization. For both perceived quality and reported instrumental use, these analyses found that policy briefs signed by the African university (scientific authority) were associated with lower scores than policy briefs signed by the North American/European university.
The results confirm the significant influence of sources on perceived global health knowledge and the intersectionality of sources of influence. This analysis allows us to learn more about organizations in global health leadership, and to reflect on the implications for knowledge translation practices.
Given the importance of the continuous follow-up of chronic patients, we evaluated the performance of French private practice general practitioners (GPs) practicing in multi-professional group practices (MGP) regarding chronic care management during the first Covid-19 lockdown in Spring 2020 compared to GPs not in MGP. We consider two outcomes: continuity of care provision for chronic patients and proactivity in contacting these patients.
The cross-sectional web questionnaire of 1191 GPs took place in April 2020. We exploit self-reported data on: 1) the frequency of consultations for chronic patients during lockdown compared to their "typical" week before the pandemic, along with 2) GPs' proactive behaviour when contacting their chronic patients. We use probit and bivariate probit models (adjusted for endogeneity of choice of engagement in MGP) to test whether GPs in MGP had significantly different responses to the Covid-19 crisis compared to those practicing outside MGP.
Out of 1191 participants (response rate: 43.1%), around 40% of GPs were female and 34% were younger than 50 years old. Regression results indicate that GPs in MGP were less likely to experience a drop in consultations related to complications of chronic diseases (- 45.3%). They were also more proactive (+ 13.4%) in contacting their chronic patients compared to their peers practicing outside MGP.
We demonstrate that the MGP organisational formula was beneficial to the follow-up of patients with chronic conditions during the lockdown; therefore, it appears beneficial to expand integrated practices, since they perform better when facing a major shock. Further research is needed to confirm the efficiency of these integrated practices outside the particular pandemic setup.
This paper proposes a new empirical conceptualization of financial integration of sovereign bond markets in the euro area. We introduce a methodology based on the joint testing of the assumptions of efficient market and convergence/divergence of the yield spreads. We test these assumptions by proposing parametric and non-parametric techniques. We find that markets have been more fragmented than usually advocated in the literature. We also show that the information contained in the fundamentals are not always fully reflected in the spreads, which suggests that either they have insignificant effects, or that their coefficients in the spread equations appear with the wrong sign.
La Revue économique rend hommage à Philippe Mongin, figure marquante de l’économie théorique et de la philosophie des sciences sociales, récipiendaire du Prix de la Revue en 2020 et décédé la même année à l’âge de 70 ans. Dans ce numéro spécial sont rassemblées des contributions qui montrent la diversité et la fécondité de ses travaux dans des domaines aussi variés que l’épistémologie de l’économie, l’application de la théorie des jeux en histoire, l’économie du bien-être ou encore l’agrégation des jugements. /
We build up a general purpose decision model to predict the choice between going to war and staying at peace for a rational decision-maker. This model articulates root causes such as the risk of future war and parameters such as potential gains in case of victory, potential losses in case of defeat, the probability of victory and the war human losses. We apply and calibrate this model to the case of German and French decision-makers at the very end of July 1914, taking into account the decisions already taken by Austria-Hungary and Russia and the uncertainty surrounding the decision of Great Britain. We assume a short war that does not last beyond 1914. Our model predicts the entry into the war of Germany and France, the argument of preventive war (going to war today rather than tomorrow) proving to be decisive for both countries, with the added benefit for France of the potential recovery of Alsace-Moselle in the event of victory. The computation reveals that of the two countries, it was France that seems to have the most interest in the war, making it possible to explain the passive behavior of the French leaders, Raymond Poincare in the first place, who, if they did not provoke the war, did not really try to avoid it either.
We analyze the integration of intermittent renewables-based technologies into an electricity mix comprising of conventional energy. Intermittency is modeled by a contingent electricity market and we introduce demand-side flexibility through the retailing structure. Retailers propose diversified electricity contracts at different prices, but in an insufficient number to cover intermittent production. These delivery contracts are modeled similarly to numeraire assets. We study the competitive equilibrium of the state-contingent wholesale electricity markets and the delivery contract markets. We also provide an analysis linking the delivery contracts to social welfare. Finally, we discuss the conditions under which changing the delivery contracts improve penetration of renewables and increases welfare. These provide useful insights for managing intermittency and achieving renewable capacity objectives.
Taking advantage of an original firm-level survey carried out by the Banque de France, we empirically investigate how the employment of ICT specialists (in-house and external) and the use of digital technologies (cloud and big data) have an impact on firm productivity and labor share. Our analysis relies on the survey responses in 2018 of 1,065 French firms belonging to the manufacturing sector and with at least 20 employees. To tackle potential endogeneity issues, we adopt an instrumental variable approach as proposed by Bartik (1991, Who Benefits from State and Local Economic Development Policies? Kalamazoo, MI: W.E. Upjohn Institute for Employment Research.). The results of our cross-section estimations point to a large effect: ceteris paribus, the employment of ICT specialists and the use of digital technologies improve a firm’s labor productivity by about 23% and its total factor productivity by about 17%. Conversely, the employment of in-house ICT specialists and the use of big data both have a detrimental impact on labor share, of about 2.5 percentage points respectively.
We provide an estimate of the environmental impact of the recruitment system in the economics profession, known as the “international job market for economists”. Each year, most graduating PhDs seeking jobs in academia, government, or companies participate in this job market. The market follows a standardized process, where candidates are pre-screened in a short interview which takes place at an annual meeting in Europe or in the United States. Most interviews are arranged via a non-profit online platform, econjobmarket.org, which kindly agreed to share its anonymized data with us. Using this dataset, we estimate the individual environmental impact of 1057 candidates and one hundred recruitment committees who attended the EEA and AEA meetings in December 2019 and January 2020. We calculate that this pre-screening system generated the equivalent of about 4800 tons of avoidable CO2-eq and a comprehensive economic cost over €4.4 million. We contrast this overall assessment against three counterfactual scenarios: an alternative in-person system, a hybrid system (where videoconference is used for some candidates) and a fully online system (as it happened in 2020–21 due to the COVID-19 pandemic). Overall, the study can offer useful information to shape future recruitment standards in a more sustainable way.