Showing papers by "Florence Jusot published in 2012"
Posted Content•
TL;DR: In this article, the authors examined the variations in utilisation of preventive services by the population aged 50 and over in 14 European countries, pooling data from the two waves of Survey of Health Ageing and Retirement in Europe and the British Household Panel Survey.
Abstract: Prevention has been identified as an effective strategy to lead healthy, active and independent lives in old age. Developing effective prevention programs requires understanding the influence of both individual and health system level factors on utilisation of specific services. This study examines the variations in utilisation of preventive services by the population aged 50 and over in 14 European countries, pooling data from the two waves of Survey of Health Ageing and Retirement in Europe and the British Household Panel Survey. The models used allow for the impact of individual level demand-side characteristics and supply-side health systems features to be separately identified. The analysis shows significant variations in preventive care utilisation both within and across European countries. In all countries, controlling for individual health status and country-level systemic differences, higher educated and higher income groups use more preventive services. At the health system level, high public health expenditures and high GP density is associated with a high level of preventive care use, but specialist density does not appear to have any effect. Moreover, payment schemes for GPs and specialists appear to significantly affect the incentives to provide preventive health care. In systems where doctors are paid by fee-for-service the utilisation of all health services, including cancer screening, are higher.
67 citations
TL;DR: Examination of variations in utilisation of preventive services by the population aged 50 and over in 14 European countries, pooling data from the two waves of Survey of Health Ageing and Retirement in Europe and the British Household Panel Survey shows higher educated and higher income groups use more preventive services.
Abstract: Prevention has been identified as an effective strategy to lead healthy, active and independent lives in old age. Developing effective prevention programs requires understanding the influence of both individual and health system level factors on utilisation of specific services. This study examines the variations in utilisation of preventive services by the population aged 50 and over in 14 European countries, pooling data from the two waves of Survey of Health Ageing and Retirement in Europe and the British Household Panel Survey. The models used allow for the impact of individual level demand-side characteristics and supply-side health systems features to be separately identified. The analysis shows significant variations in preventive care utilisation both within and across European countries. In all countries, controlling for individual health status and country-level systemic differences, higher educated and higher income groups use more preventive services. At the health system level, high public health expenditures and high GP density is associated with a high level of preventive care use, but specialist density does not appear to have any effect. Moreover, payment schemes for GPs and specialists appear to significantly affect the incentives to provide preventive health care. In systems where doctors are paid by fee-for-service the utilisation of all health services, including cancer screening, are higher.
63 citations
TL;DR: In this article, the authors investigated the long-term effects of early-life conditions with comparison to lifestyles and educational attainment on health status in a cohort of British people born in 1958.
Abstract: The paper focuses on the long-term effects of early-life conditions with comparison to lifestyles and educational attainment on health status in a cohort of British people born in 1958. Using the longitudinal follow-up data at age 23, 33, 42 and 46, we build a dynamic model to investigate the influence of each determinant on health and the mediating role of education and lifestyles in the relationship between early-life conditions and later health. Direct and indirect effects of early-life conditions on adult health are explored using auxiliary linear regressions of education and lifestyles and panel Probit specifications of self-assessed health with random effects addressing individual unexplained heterogeneity. Our study shows that early-life conditions are important parameters for adult health accounting for almost 20% of explained health inequality when mediating effects are identified. The contribution of lifestyles reduces from 32% down to 25% when indirect effects of early-life conditions and education are distinguished. Noticeably, the absence of father at the time of birth and experience of financial hardships represent the lead factors for direct effects on health. The absence of obesity at 16 influences health both directly and indirectly working through lifestyles.
45 citations
25 Nov 2012
TL;DR: In this paper, the authors analyze des determinants du renoncement aux soins pour raisons financieres puis d'etudier ses consequences sur l'evolution of l'etat de sante quatre ans plus tard a partir des donnees de l'Enquete Sante ProtectionSociale.
Abstract: Cet article propose d’analyser des determinants du renoncement aux soins pour raisons financieres puis d’etudier ses consequences sur l’evolution de l’etat de sante quatre ans plus tard a partir des donnees de l’Enquete Sante ProtectionSociale. L’analyse des determinants du renoncement montre le role important joue par l’acces a une couverture complementaire, au cote de celui de la situation sociale presente, passee et anticipee. L’analyse montre ensuite que le renoncement aux soins a un effet causal sur la degradation de l’etat de sante ulterieur. Elle suggere ainsi que les difficultes d’acces aux soins contribuent aux inegalites de sante.
36 citations
01 Jan 2012
TL;DR: The more dis-advantaged economic and social status of immigrants, their lower access to complementary health coverage, and their lower social integration are the most important factors explaining these health and health care inequalities.
Abstract: L’etat de sante des immigres est considere comme un veritable enjeu de sante publique en raison de la fragilisation economique et sociale que peuvent connaitre certains d’entre eux, et qui participe a la deterioration de leur etat de sante.
Ce bilan des etudes francaises sur l’etat de sante et l’acces aux soins des immigres suggere l’existence d’inegalites de sante liees a la migration et
de disparites selon le pays d’origine. En outre, l’ensemble des etudes s’ac-
corde sur le moindre recours aux soins de la population immigree, revelant des difficultes d’acces a la medecine de ville. Enfin, la situation economique et sociale plus defavorisee des immigres, leur moindre acces a la complementaire sante et leur moindre integration sociale sont les principaux facteurs expliquant ces inegalites de sante et d’acces aux soins.
Ces travaux appellent a une modification des politiques sanitaires et sociales visant a ameliorer l’etat de sante et l’acces aux soins des populations d’origine etrangere.
35 citations
15 Nov 2012
TL;DR: In this article, the contribution du capital social a l'explication des differences d'etat de sante entre la population immigree and la population native en France a partir des donnees de l'Enquete sante protection sociale (ESPS) menee en 2006 and 2008.
Abstract: Cet article etudie la contribution du capital social a l’explication des differences d’etat de sante entre la population immigree et la population native en France a partir des donnees de l’Enquete sante protection sociale (ESPS) menee en 2006 et 2008. L’utilisation de la methode de decomposition proposee par Fairlie montre que 38,7 % des differences d’etat de sante entre les deux populations sont liees a une difference de distribution des caracteristiques observables. Alors que l’âge contribue negativement aux disparites de sante, les resultats indiquent que le capital social presente la contribution la plus importante (53,9 %) devant le revenu (42,5 %) et la Profession et categorie socioprofessionnelle (PCS) (16 %).
24 citations
01 Jan 2012
TL;DR: This paper propose a synthese des travaux francais portant sur l'etat de sante and le recours aux soins des migrants depuis une trentaine d'annees.
Abstract: Cette etude propose une synthese des travaux francais portant sur l’etat de sante et le recours aux soins des migrants depuis une trentaine d’annees. Malgre la divergence des resultats de la litterature - due notamment a la diversite des indicateurs utilises et des periodes considerees -, cette synthese souligne l’existence de disparites entre les populations francaise et immigree.
De meilleur, l’etat de sante des immigres est devenu moins bon que celui des Francais de
naissance. Ces differences sont plus marquees chez les immigres de premiere generation, les femmes, et varient selon le pays d’origine. Un moindre recours aux soins de ville et a la prevention a egalement ete constate.
Si des phenomenes de selection lies a la migration permettent d’expliquer le meilleur etat de sante initial des immigres, leur situation economique fragilisee dans le pays d’accueil ainsi que la deterioration du lien social contribuent notamment a la degradation de leur etat de sante et a leur moindre recours aux soins.
Ce constat appelle la mise en œuvre de politiques de sante publique adaptees visant a ameliorer l’etat de sante et l’acces aux soins des populations d’origine etrangere, notamment a travers la
prevention, le developpement d’actions de proximite et de simplification de l’acces a certains droits et dispositifs tels que la Couverture maladie universelle ou l’Aide medicale d’Etat.
20 citations
TL;DR: Subjects who had achieved intergenerational upward mobility as well as those who had remained in the upper class were more likely to receive transfers, suggesting that parents rewarded those of their children who achieved most social success.
15 citations
Posted Content•
01 Jan 2012
TL;DR: The authors investigated the relation of financial transfers from parents to their adult children to their beneficiaries' health in France and found that those who had been given large transfers were much more likely to report very good health than subjects who had not been given anything.
Abstract: Financial transfers from parents to their adult children are a growing trend in contemporary societies, and this study investigates the relation of those transfers to their beneficiaries' health in France. In the 2005 nationally representative Gender and Generation Survey, nearly 6% of the subjects aged 25–49 years reported having received financial transfers during the last 12 months. Subjects who had achieved intergenerational upward mobility as well as those who had remained in the upper class were more likely to receive transfers, suggesting that parents rewarded those of their children who achieved most social success. After adjusting for a wide range of socio-demographic factors, subjects who had been given large transfers were much more likely to report very good health than subjects who had not been given anything. Findings were interpreted within the framework of sociological research on intergenerational transfers and that of lifecourse epidemiology.
11 citations
01 Jan 2012
TL;DR: In this article, a revue de litterature ciblee sur les interventions efficaces dans ce domaine is presented, which concerne le developpement de la prevention de la sante ; le second, lamelioration de lacces financier aux soins en direction de populations specifiques; and le troisieme, les pratiques qui visent a ameliorer la qualite des soins, pour l'ensemble de la population, dans le cadre d'un reamenagement de l’
Abstract: Apres avoir rappele la definition des soins primaires et explique leur role en tant que principes organisateurs des systemes de soins pour reduire les inegalites sociales de sante, nous presentons une revue de litterature ciblee sur les interventions efficaces dans ce domaine. Cette revue de litterature a ete realisee dans le cadre du projet europeen AIR (Addressing Inequalities Interventions in Regions). Trois champs d’intervention en soins primaires ont ete distingues : le premier concerne le developpement de la prevention de la sante ; le second, l’amelioration de l’acces financier aux soins en direction de populations specifiques ; et le troisieme, les pratiques qui visent a ameliorer la qualite des soins, pour l’ensemble de la population, dans le
cadre d’un reamenagement de l’organisation du systeme de soins.
10 citations
Posted Content•
TL;DR: In this paper, the influence of social background and social situation on the smoking career was explored based on a sample of 4.473 individuals who answered the 2006 French Health, Health Care and Insurance Survey.
Abstract: This article explores the influence of social background and social situation on the smoking career. This study is based on a sample of 4.473 individuals who answered the 2006 French Health, Health Care and Insurance Survey. The results of a non-parametric analysis and of a stratified Cox model show an increase of the risk of initiation and a decrease of the risk of cessation with parental smoking. They also emphasis a reversion of the social gradient between initiation and cessation. Individuals with high social background and high socioeconomic status have both a higher risk of initiation and a higher risk of cessation. Finally, being son of farmers is protective for both initiation and cessation.
TL;DR: In this paper, the authors propose an approche cout-benefice, which is based on the sum of the consentements of individuels a payer to a politique of sante.
Abstract: Deux methodes sont generalement envisagees pour l'evaluation des politiques de sante. L'approche cout-benefice s'appuie sur la somme des consentements individuels a payer : elle respecte les preferences individuelles mais elle donne une priorite aux preferences des plus riches car leurs consentements a payer sont en general plus eleves. L'approche cout-efficacite selectionne les politiques assurant le gain le plus eleve en matiere de sante globale, a cout total donne. Elle n'avantage pas les individus a revenu eleve, mais elle peut avoir d'autres effets indesirables : par exemple favoriser le traitement d'une affection benigne qui profitera au plus grand nombre par rapport a une affection grave touchant peu de personnes. Une variante de l'analyse cout-benefice evite ces differents ecueils. Elle consiste a ponderer les consentements a payer par des coefficients qui varient en sens inverse d'un indicateur de bien-etre individuel combinant revenu et etat de sante. L'indicateur choisi est le revenu equivalent sante : il s'agit du revenu effectif de l'individu diminue du montant auquel il serait pret a renoncer pour etre en parfaite sante. A revenu donne, il decroit donc quand la sante se deteriore. Contrairement a des indices d'utilite subjective, il a l'avantage de ne s'appuyer que sur les preferences ordinales des individus. Cette approche est mise en œuvre a l'aide d'une enquete conduite sur un echantillon representatif de la population francaise. Compte tenu de leurs contraintes financieres, les personnes a bas revenu accordent moins d'importance relative a leur etat de sante. Mais les coefficients obtenus permettent neanmoins de surponderer les individus les moins favorises cumulant faible revenu, mauvaise sante et forte preference pour l'amelioration de cette sante. Ces coefficients sont ensuite mobilisables pour l'evaluation de toute politique pour laquelle on connaitrait les consentements individuels a payer.
25 Nov 2012
TL;DR: In this paper, the authors study the influence of the milieu d'origine and the situation social on the parcours tabagique, and find that le tabagisme des parents augmente le risque d’initiation and reduit les chances de cessation.
Abstract: Cet article etudie l’influence du milieu d’origine et de la situation sociale sur le parcours tabagique. Cette etude s’appuie sur un echantillon de 4 473 individus ayant repondu aux questions sur le milieu d’origine introduites dans l’Enquete sante et protection sociale en 2006. Les resultats d’une analyse non parametrique et de l’estimation de modeles de Cox stratifies montrent tout d’abord que le tabagisme des parents augmente le risque d’initiation et reduit les chances de cessation. Ils revelent ensuite une inversion du gradient social entre l’initiation et la cessation. Alors que les enquetes les plus eduques et issus d’un milieu favorise presentent un risque d’initiation plus eleve, ils ont plus de chances de connaitre une cessation precoce, tout comme les enquetes ayant une situation sociale actuelle favorable. Les enfants d’agriculteurs ont enfin moins de risque de commencer a fumer et plus de chances de s’arreter.
Posted Content•
TL;DR: In this article, a review of French studies on migrant health status and access to care suggests the existence of health inequalities related to migration and some disparities according to the country of origin.
Abstract: The health status of immigrants is considered as a genuine public health concern due to the economic and social fragility that they may experience, which contributes to the deterioration of their health. This review of French studies on migrant health status and access to care suggests the existence of health inequalities related to migration and some disparities according to the country of origin. In addition, the body of evi-dence shows a lesser use of health care among the migrant population, suggesting difficulties in accessing ambulatory care. Finally, the more dis-advantaged economic and social status of immigrants, their lower access to complementary health coverage, and their lower social integration are the most important factors explaining these health and health care inequalities. These studies call for health and social policy reforms designed to improve the health status and health care use of the foreign born population.
Posted Content•
TL;DR: In this article, des enquetes enregistrent une augmentation des chiffres de renoncement aux soins dans l'ensemble de la societe francaise, ce qui traduit un echec des strategies actuelles de reduction des depenses de sante.
Abstract: Depuis plusieurs annees, des enquetes enregistrent une augmentation des chiffres de renoncement aux soins dans l’ensemble de la societe francaise, ce qui traduit un echec des strategies actuelles de reduction des depenses de sante. Mais quelles sont les pistes alternatives ?
TL;DR: The contribution of inequity in access to care to health inequalities is disputable and the consequences in term of health status and future health care consumption of horizontal inequities in health care use have scarcely been explored.
Abstract: Context Several studies provide evidence of horizontal inequities in health care use in France, i.e. differences in health care utilization for equal needs in favor of the highest socioeconomic groups [1-3]. Similarly, significant social inequalities in mortality have been found in France in comparison with other European countries [4]. However, the contribution of inequity in access to care to health inequalities is disputable and the consequences in term of health status and future health care consumption of horizontal inequities in health care use have scarcely been explored.
TL;DR: Aide complementaire sante (ACS) ou « cheque sante '' ou '' cheques sante'' ou "Cheque Sante'' (CS) as mentioned in this paper is a scheme mise en place en 2005 by l'Universite Paris-Dauphine a Lille aupres d'un echantillon de 4 209 assures sociaux potentiellement eligibles.
Abstract: L'Aide complementaire sante (ACS) ou « cheque sante » a ete mise en place en 2005 pour inciter les menages dont le niveau de vie se situe juste au-dessus du plafond CMU-C a acquerir une couverture complementaire sante grâce a une subvention. Meme si le nombre de beneficiaires a lentement progresse depuis son introduction, le recours a l'ACS reste faible. Deux hypotheses peuvent expliquer cet etat de fait : (1) le defaut d'information sur l'existence du dispositif, son fonctionnement et sur les demarches a entreprendre pour en beneficier ; (2) un montant d'aide insuffisant, la complementaire resterait trop chere meme apres deduction de l'aide. Afin de tester la validite de ces deux hypotheses, une experimentation sociale controlee a ete mise en place par l'universite Paris-Dauphine a Lille aupres d'un echantillon de 4 209 assures sociaux potentiellement eligibles a l'ACS. Un montant majore d'aide ainsi qu'un acces differencie a l'information sur le dispositif ont ete proposes de maniere aleatoire a certains assures. Les resultats montrent de maniere robuste que la majoration du montant du « cheque sante » ameliore legerement le taux de recours a l'ACS et permet de mieux cibler les personnes effectivement eligibles. Toutefois, l'ACS reste un dispositif complique qui touche difficilement sa cible : au total, seuls 17 % des assures ont fait une demande d'ACS. Seuls 9 % des assures invites a participer a une reunion d'information y ont effectivement assiste, et l'invitation a cette reunion a largement decourage les autres assures, annulant ainsi l'effet de la majoration du cheque. Enfin, seuls 55 % des assures ayant depose une demande ont recu l'aide, les autres s'etant vu refuser l'aide en raison, le plus souvent, de ressources trop elevees. La difficulte a cibler la population eligible et l'incertitude importante sur l'eligibilite qui en resulte sont certainement des freins s'ajoutant a la complexite des demarches.
01 Dec 2012
TL;DR: The long term influence of social background and parental habits on adulthood health care use, which contributes to the intergenerational transmission of health inequalities is shown.
Abstract: This article explores the intergenerational transmission of health care habits and the related differences in terms of health care and prevention use. Our study is based on a sample of 4 613 individuals who answered the 2010 French Health, Health Care and Insurance Survey and completed the specific questions about health care and prevention use and living conditions during childhood. Results provide evidence of an intergenerational transmission of health care preferences. More precisely, we show a transmission of health care habits and an influence of parental habits during childhood on the conditional number of general practitioner and specialist visits and on the use of preventive health service namely colon cancer screening. We also find a long term influence of maternal education on the use of smear test. This study shows the long term influence of social background and parental habits on adulthood health care use, which contributes to the intergenerational transmission of health inequalities.
TL;DR: In this paper, des enquetes enregistrent une augmentation des chiffres de renoncement aux soins dans l'ensemble de la societe francaise, ce qui traduit un echec des strategies actuelles de reduction des depenses de sante.
Abstract: Depuis plusieurs annees, des enquetes enregistrent une augmentation des chiffres de renoncement aux soins dans l’ensemble de la societe francaise, ce qui traduit un echec des strategies actuelles de reduction des depenses de sante. Mais quelles sont les pistes alternatives ?
TL;DR: This research presents a novel probabilistic procedure called “spot-spot analysis” that allows for real-time analysis of the response of the immune system to drugs.
Abstract: The first stage of our analysis consisted of estimating the association between the probability of using each given service (Cij) and several individual explanatory variables (Xij: age, sex, education income, health status). The slope coefficients b of the individual explanatory variables were treated as fixed across countries. However, a random country intercept b0j was introduced in the model in order to take into account the differences between country in the average level of use a given health service. Across countries, the country intercepts b0j were assumed to be normally distributed with a mean b0 and a variance r . The estimate of the variance r provided then a measure of the differences in health care use across countries after controlling for compositional effect due to individual characteristics. If r was significantly different from zero, it indicated that the level of health services use significantly varies from one country to another. The second stage of the analysis aimed to establish the association between various health system features and the probability of service utilisation at the country level. In order to explain the variation in health care use across countries shown by the first stage of this analysis, health systems variables were introduced, in addition to individual characteristics. A random country intercept x0j (normally distributed) was also introduced in the model in order to control for unobserved country-level factors influencing preventive care use independently of health system characteristics.
Posted Content•
TL;DR: In this paper, a revue de litterature ciblee sur les interventions efficaces dans ce domaine is presented, which concerne le developpement de la prevention de la sante ; le second, l amelioration de l'acces financier aux soins en direction de populations specifiques; and le troisieme, les pratiques qui visent a ameliorer la qualite des soins, pour l'ensemble de la population, dans le cadre d'un reamenagement de l
Abstract: Apres avoir rappele la definition des soins primaires et explique leur role en tant que principes organisateurs des systemes de soins pour reduire les inegalites sociales de sante, nous presentons une revue de litterature ciblee sur les interventions efficaces dans ce domaine. Cette revue de litterature a ete realisee dans le cadre du projet europeen AIR (Addressing Inequalities Interventions in Regions). Trois champs d'intervention en soins primaires ont ete distingues : le premier concerne le developpement de la prevention de la sante ; le second, l'amelioration de l'acces financier aux soins en direction de populations specifiques ; et le troisieme, les pratiques qui visent a ameliorer la qualite des soins, pour l'ensemble de la population, dans le cadre d'un reamenagement de l'organisation du systeme de soins.