Alain Paraponaris

Chercheur ,  Aix-Marseille Université , Faculté d'économie et de gestion (FEG)

Économie publique
Paraponaris
Statut
Professeur des universités
Domaine(s) de recherche
Économie de la santé
Thèse
1998, École des hautes études en sciences sociales
Téléchargement
CV
Contact
alain.paraponaris[at]univ-amu.fr
Adresse

AMU - AMSE
5-9 Boulevard Maurice Bourdet, CS 50498
​13205 Marseille Cedex 1

Site
https://sites.google.com/view/page-perso-alainparaponaris/accueil-home
Résumé Cancer accounts for approximately one-third of deaths in developed countries. Preventing cancer, notably by detecting new cases early, is thus crucial. In the European Union (EU), screening rates have been recommended for several types of cancer; however, most EU countries are still not meeting them. Determining how we can improve people’s adherence to screening is necessary. This study aimed to explore the characteristics of women associated with being up-to-date on mammograms or Pap smears; notably, we wanted to determine the extent to which women’s attitudes towards risk play a role in their adherence to screening. The sample comprised 1411 women who responded to a telephone survey. The survey data, including sociodemographic characteristics, health information, attitudes towards the future, and attitudes towards risk, collected via the Domain-Specific Risk-Taking (DOSPERT) scale, were supplemented by medico-administrative data. The factors associated with undergoing either a mammogram or a Pap smear in a timely manner were similar. Two favourable factors were found: the number of children and a high level of education. In contrast, being older or having a higher DOSPERT score for risk-taking appeared to be negatively associated with timely screening. The fact that women’s attitudes towards risk seem to have a strong impact on their adherence to medical recommendations is a finding that should be considered (e.g. by health professionals or in prevention campaigns) regarding increasing women’s awareness of the importance of regular cancer screening.
Mots clés Mammography, Prevention, Screening test, Cancer screening, Risk-taking behavior, Vaginal smears, Telephone, Health personnel, European union, Educational status, Developed countries, Child, Attitude, Cancer
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Résumé Background. 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.
Mots clés HEALTH PROMOTION, Return to work, Sick leave, Social security, Disease
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Résumé Purpose 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. Methods 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. Results 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%. Conclusions 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.
Mots clés France, VICAN5, Continued employment, Workplace accommodations, Cancer survivors
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Résumé Background: Compared to 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. Methods: 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-indifferences (DiD) models were used to compare both the monetary value and physical quantities of healthcare consumption before and after the change in coverage. Results: As expected, the DiD models revealed a strong 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. Conclusion: Both catching-up behaviour and moral hazard are likely to play a role in the increase observed in healthcare consumption.
Mots clés Difference-in-differences, Exact matching, Longitudinal data, Healthcare consumption, Moral hazard, Complementary health insurance
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Résumé Background: 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. Methods: 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. Results: 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
Mots clés Feelings, Living arrangements, Cancer diagnosis, Cancer survivors, Job reentry, Statutes and laws, Diagnosis, Workplace, Survivors, Employment, Chronic disease, Cancer
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Résumé 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.
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Résumé 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.
Mots clés Influenza vaccines, Disabled persons, Socioeconomic factors, Social determinants of health France
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Résumé 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.
Mots clés Economie quantitative
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Mots clés Self-employment, Work ability, HEALTH PROMOTION, Sick leave, Employment, Cancer survivor
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Résumé Purpose: The aim of this study is to investigate whether salaried and self-employed workers differ regarding factors relevant for return to work after being diagnosed with cancer. The possible mediators of an effect of self-employment on work ability were also investigated. Methods: A total of 1115 cancer survivors (1027 salaried and 88 self-employed) of common invasive cancer types who were in work at the time of diagnosis completed a mailed questionnaire 15–39 months after diagnosis. Results: Twenty-four percent of self-employed cancer survivors reported that they had not returned to work at the time of the survey, and 18 % of those who were salaried had not. While 9 % of the self-employed had received disability or early retirement pension, only 5 % had received such a pension among salaried employees. Compared with the salaried workers, the self-employed people reported significantly more often reduced work hours (P < 0.001), negative cancer-related financial (P < 0.001), and occupational changes (P = 0.005) and low overall health (P = 0.02), quality of life (P = 0.04), and total work ability (P = 0.02). The negative effect of self-employment on total work ability seems to be mediated by reduced work hours and a negative cancer-related financial change. Conclusions: Compared with salaried, self-employed workers in Norway, they seem to struggle with work after cancer. This may be because the two groups have different work tasks and because self-employed people have lower social support at work and less legal support from the Working Environment Act and public health insurance.
Mots clés Self-employment, Work ability, HEALTH PROMOTION, Sick leave, Employment, Cancer survivor
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Résumé 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
Mots clés Economie quantitative
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Résumé 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.
Mots clés Ambulatory care sensitive conditions, International, Potential cost savings, International comparisons JEL Classification I11, I18, H51, Preventable admissions
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Résumé 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.
Mots clés Economie quantitative
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Résumé 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.
Mots clés Economie quantitative
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Résumé 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.
Mots clés Economie quantitative
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Résumé Geographic variation in use of elective surgeries has been widely studied in the US, where over-utilization is incentivized. We wanted to explore recent trends in the geographic variation of common surgical procedures in France – where a global budget, centralized planning process, and compulsory insurance scheme are in place – and to compare measures of variation there to those in the US and Britain. For 2008–2010, we calculated French age- and sex-adjusted per capita utilization rates and four measures of geographic variation for hip fracture admission (which is standard treatment and shows minimal geographic variation across countries) and 14 elective surgical procedures. We found substantial geographic variation in age-sex adjusted per capita admission rates for elective procedures: radical prostatectomy, spine surgery, and CABG showed the greatest variation, while hip fracture, colectomy, and cholecystectomy showed the least. Among older patients, most French admission rates were lower than those seen in the US. In general, measures of geographic variation were lower in France than those reported in the US or Britain. French policymakers could use analyses of geographic variation in service utilization to inform policy, to identify areas for intervention, or to measure the effectiveness of efforts designed to reduce variation in care.
Mots clés Surgical procedures, Policy development, Geographic variation
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Résumé INTRODUCTION: We sought to determine whether there was evidence of supplier-induced demand in mainland France, where health care is mainly financed by a public and compulsory health insurance and provided by both for-profit and not-for-profit hospitals. METHODS: Using a dataset of all admissions to French hospitals for 2009 and 2010, we calculated department-level age-adjusted and sex-adjusted per capita admission rates for hip replacement, knee replacement, and hip fracture for 2 age groups (45-64 and 65-99 y old), for-profit and not-for-profit hospitals. We used spatial regression analysis to examine the relationship between ecological variables, procedure rates, and supply of surgeons or sector-specific surgical beds. RESULTS: The large majority of hip and knee replacement surgeries were performed in for-profit hospitals, whereas the large majority of hip fracture admissions were in not-for-profit hospitals; nonetheless, we found approximately 2-fold variation in per capita rates of hip and knee replacement surgery in both age groups and settings. Spatial regression results showed that among younger patients, higher incomes were associated with lower admission rates; among older patients, higher levels of reliance on social benefits were associated with lower rates of elective surgery in for-profit hospitals. Although overall surgical bed supply was not associated with admission rates, for-profit-specific and not-for-profit-specific bed supply were associated with higher rates of elective procedures within a respective hospital type. DISCUSSION: We found evidence of supplier-induced demand within the French for-profit and not-for-profit hospital systems; however, these systems appear to complement one another so that there is no overall national supplier-induced effect.
Mots clés Male, Aged, Aged, 80 and over, Arthroplasty, Replacement, Hip, Hip/statistics &amp, numerical data, Knee, Knee/statistics &amp, numerical data, Patient Admission/statistics &amp, numerical data, Patient Admission, Middle Aged, Bias Epidemiology, Knee Injuries/therapy, Knee Injuries, Humans, Voluntary/utilization, Voluntary, Proprietary/statistics &amp, numerical data, Proprietary, Hospitals, Hip Fractures/therapy, Hip Fractures, Health Services Needs and Demand/statistics &amp, numerical data, Health Services Needs and Demand, France, Female
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Résumé 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
Mots clés Cooperation, Paiement à la performance, Médecins généralistes
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Résumé En France, la couverture vaccinale est insuffisante. Les médecins généralistes étant des acteurs essentiels de la politique vaccinale, il est utile de connaître leurs opinions et pratiques à ce sujet. Nous avons interrogé 1431 médecins généralistes français et 98% se déclaraient favorables à la vaccination dans leur pratique quotidienne. Leurs couvertures vaccinales étaient de 73% pour l’hépatite B, 64% pour la coqueluche et 77% pour la grippe saisonnière. Les médecins se trouvaient très efficaces pour obtenir l’adhésion pour le vaccin ROR (Rougeole-Oreillons-Rubéole) chez les enfants de moins de deux ans et la grippe saisonnière chez les adultes de moins de 65 ans à risque, mais beaucoup moins pour l’hépatite B chez les adolescents. La mise en place d’un registre national informatisé des vaccinations et de messages de promotion vaccinale différenciés par vaccin semblent les deux voies prioritaires pour améliorer la couverture vaccinale.
Mots clés Promotion de la santé, Prevention, Pratiques, Comportement de santé, Maladies transmissibles
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Résumé Objectif – Garantir un accès aux soins bucco-dentaires équitable et de qualité aux personnes âgées reste un défi. Ce travail a pour objectif de comparer le recours au chirurgien-dentiste des personnes âgées institutionnalisées à celui des personnes âgées vivant à domicile. Méthode – Les données analysées, restreintes aux sujets de plus de 60 ans, sont issues de l’enquête Handicap-Santé menée en France en ménages ordinaires (HSM) et en institutions (HSI). La technique d’appariement par score de propension a été utilisée afin de permettre la comparaison des deux populations en minimisant les biais. Les variables d’appariement étaient l’âge, le sexe, le degré de dépendance, la catégorie socioprofessionnelle et la fréquence des contacts avec la famille. Résultats – Un sous-échantillon de 3 358 sujets âgés (1 679 paires) a été constitué. La probabilité de recours au chirurgien-dentiste est diminuée d’un quart lorsque les personnes sont institutionnalisées (OR=0,7 ;p \textless0,001) par rapport aux personnes vivant à domicile. Pour les personnes institutionnalisées, le recours au chirurgien-dentiste apparaît cependant plus fréquent dans les établissements privés à but non lucratif que dans les structures publiques ou privées à but lucratif. Conclusion – Toutes choses égales par ailleurs, la vie en institution peut être considérée comme une barrière pour le recours au chirurgien-dentiste.
Mots clés Economie quantitative
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Résumé Women represent a growing proportion of the physician workforce, worldwide. Therefore, for the purposes of workforce planning, it is increasingly important to understand differences in how male and female physicians work and might respond to financial incentives. A recent survey allowed us to determine whether sex-based differences in either physician income or responses to a hypothetical increase in reimbursement exist among French General Practitioners (GPs). Our analysis of 828 male and 244 female GPs' responses showed that females earned 35% less per year from medical practice than their male counterparts. After adjusting for the fact that female GPs had practiced medicine fewer years, worked 11% fewer hours per year, and spent more time with each consultation, female GPs earned 11,194euro, or 20.6%, less per year (95% CI: 7085euro-15,302euro less per year). Male GPs were more likely than female GPs to indicate that they would work fewer hours if consultation fees were to be increased. Our findings suggest that, as the feminization of medicine increases, the need to address gender-based income disparities increases and the tools that French policymakers use to regulate the physician supply might need to change.
Mots clés Sex-based disparities, Productivity, Physician income, Incentives
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Résumé L'évaluation de politiques de prévention sanitaire par le recours à des Consentements A Payer (CAP) issus d'enquêtes auprès de la population est de plus en plus fréquent. Lorsque ces politiques revêtent une dimension collective, les CAP déclarés par les individus peuvent refléter une composante altruiste, ce qui rend problématique le calcul économique. A partir d'une enquête d'évaluation contingente portant sur deux politiques de prévention de la Fièvre Q, l'une collective et l'autre individuelle, nous mobilisons le cadre théorique de l'utilité espérée pour déterminer le caractère altruiste (ou non) des individus, que nous expliquons ensuite par certaines de leurs caractéristiques socio-économiques. Le principal résultat est que 66% des répondants incluent une composante altruiste lors de la révélation du CAP pour le programme collectif. Elle représente 3,6 euro en moyenne, soit environ 25% du CAP considéré.
Mots clés Altruisme
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Résumé Tis paper examines the efectiveness of France’s organized cancer screening programs by leveraging age-based eligibility thresholds to identify causal efects on screening uptake. Using 2019 telephone survey data matched with medico-administrative records from 1,411 women insured by MGEN, we employ a fuzzy regression discontinuity design to estimate Local Average Treatment Efects at program entry and exit ages. Our results reveal dramatic discontinuities in screening behavior: entering mammography screening eligibility at age 50 increases uptake probability by 59 percentage points (pp) (p
Mots clés Cancer screening test uptake, Fuzzy regression discontinuity, Atitude towards risk
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Résumé We provide a comprehensive picture of the change in the health status for the self-employed aged 50 and upwards in Europe. We find that self-employed workers are in better physical health than employees at younger ages, due potentially to a selection effect. We also find a negative effect of self-employment status on objective health, leading to worse physical conditions at older ages, despite a catching-up of healthcare consumption after retirement. The examination of the evolution of the self-employed healthcare consumption enables us to distinguish two components: an intense health restoration effect and a regular one, corresponding to two distinct periods in their life. We interpreted the former effect as the increased probability of the self-employed to be hospitalized during their careers, meaning that the self-employed seek care later or for serious reasons only. The latter effect or the regular restoration effect meaning a greater number of medical visits for the self-employed after retirement which is potentially due to a reduction in the opportunity cost of the use of healthcare resources.
Mots clés Self-employment, Health status, Health care consumption, SHARE survey
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Résumé Anxiety and depression may have serious disabling consequences for health, social, and occupational outcomes for people who are unaware of their actual health status and/or whose mental health symptoms remain undiagnosed by physicians. This article provides a big picture of unrecognised anxiety and depressive troubles revealed by a low score on the Mental Health Inventory-5 (MHI-5) with the help of machine learning methods using the 2012 French National Representative Health and Social Protection Survey (Enquête Santé et Protection Sociale, ESPS) matched with yearly healthcare consumption data from the French Sickness Fund. Compared to people with no latent symptoms who did not declare any depression over the last 12 months, those with unrecognised anxiety or depression were found to be older, more deprived, more socially disengaged, at a higher probability of adverse working conditions, and with higher healthcare expenditures backed, to some extent, by chronic conditions other than anxiety or mood disorder.
Mots clés Tree-based methods, SHAP values, Workplace outcomes, Healthcare consumption, Mental health inventory-5 MHI-5, Unrecognised mental disorders
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Résumé Delegating tasks to paramedics is a fairly recent development in France. So far it has essentially been developed in hospitals and is incipient in general practice. This paper focuses on the willingness of general practitioner to do so. A 2012 survey of 2,000 GPs might help anticipate GPs’ willingness to delegate. This paper tests whether a more favourable funding system might help increase GP willingness. We implement a quasi-experimental design wherein GPs are randomly selected to form three groups of equal size, each of them being exposed to a different funding scheme when declaring their willingness to delegate tasks to nurses: Fully Funded (FF) by the social security administration, self-funded by GPs’ revenues (Self-Funded, SF) and half-funded by both the social security administration and GPs (Half-Funded, HF). GPs’ likelihood to favour task delegation is estimated with a probit model that especially considers a GP’s attitude towards risk (aversion or tolerance) among a set of covariates, such as age, gender, rural/urban area, GP density and funding scheme. This article shows that, first, GPs are more likely to favour delegation, when they share a lower proportion of the cost. Second, the effect of risk aversion on the likelihood of favouring delegation is not altered by the funding scheme.
Mots clés Skill mix, Task shifting, Financial incentives, France, GPs, Risk aversion
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Résumé Proxy respondents are widely used in population health surveys to maximize response rates. When surveys target frail elderly, the measurement error is expected to be smaller than selection or participation biases. However, in the literature on elderly needs for care, proxy use is most often considered with a dummy variable in which endogeneity with subjects' health status is rarely scrutinised in a robust way. Pitfalls of this choice extend beyond methodological issues. Indeed, the mismeasurement of needs for care with daily activities might lead to irrelevant social policies or to private initiatives that try to address those needs. This paper proposes a comprehensive and tractable strategy supported by various robustness checks to cope with the suspected endogeneity of proxy use to the unobserved health status of subjects in reports of needs for care with activities of daily living. Proxy respondents' subjectivity is found to inflate the needs of the elderly who are replaced or assisted in answering the questionnaire and to deflate the probability of unmet or undermet needs.
Mots clés IADLs, Endogeneity, Selection, Copula, Needs for care, ADLs, Proxy respondent, Measurement bias
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