Promoting Social Participation for Healthy Ageing - A Counterfactual Analysis from the Survey of Health, Ageing, and Retirement in Europe (SHARE)

Promoting social participation of the older population (e.g. membership in voluntary associations) is often seen as a promising strategy for 'healthy ageing' in Europe. Although a growing body of academic literature challenges the idea that the link between social participation and health is well established, some statistical evidence suggest a robust positive relationship may exist for older people. One reason could be that aged people have more time to take part in social activities (due to retirement, fewer familial constraints, etc.); so that such involvement in voluntary associations contributes to maintain network size for social and emotional support; and preserves individuals' cognitive capacities. Using SHARE data for respondents aged fifty and over in 2004, this study proposes to test these hypotheses by evaluating the contribution of social participation to self-reported health (SRH) in eleven European countries. The probability to report good or very good health is calculated for the whole sample (after controlling for age, education, income and household composition) using regression coefficients estimated for individuals who do and for those who do not take part in social activities (with correction for selection bias in these two cases). Counterfactual national levels of SRH are derived from integral computation of cumulative distribution functions of the predicted probability thus obtained. The analysis reveals that social participation contributes by three percentage points to the increase in the share of individuals reporting good or very good health on average. Higher rates of social participation could improve health status and reduce health inequalities within the whole sample and within every country. Our results thus suggest that 'healthy ageing' policies based on social participation promotion may be beneficial for the aged population in Europe.Healthy ageing, Self-reported health, Social participation, Social capital, SHARE data, Counterfactual analysis, Stochastic dominance

Working Conditions and Health of European Older Workers

Working conditions have greatly evolved in recent decades in developed countries. This evolution has been accompanied with the appearance of new forms of work organisation that may be sources of stress and health risk for older workers. As populations are ageing, these issues are particularly worrying in terms of the health, labour force participation and Social Security expenditure. This paper focuses on the links between quality of employment and the health of older workers, using the Share 2004 survey. Our research is based on two classical models: the Demand-Control model of Karasek and Theorell (1991) and the Effort-Reward Imbalance model of Siegrist (1996), which highlight three main dimensions: Demand that reflects perceived physical pressure and stress due to a heavy work load; Control that refers to decision latitude at work and the possibilities to develop new skills; and Reward that corresponds to the feeling of receiving a correct salary relatively to efforts made, of having prospects for personal progress and receiving deserved recognition. These models also take into account the notion of support in difficult situations at work and the feeling of job security. Our estimations show that the health status of older workers is related to these factors. Fairly low demand levels and a good level of reward are associated with a good health status, for both men and women. Control only influences the health status of women. Lastly, the results reveal the importance on health of a lack of support at work and the feeling of job insecurity; regardless of gender; these two factors are particularly related to the risk of depression. Thus health status and working conditions are important determinants of the labour force participation of older workers.Working conditions, Health, Older Workers

Out-of-Pocket Maximum Rules under a Compulsatory Health Care Insurance Scheme: A Choice between Equality and Equity

Using the microsimulation model ARAMMIS, this study attempts to measure the impacts of introducing an out-of-pocket (OOP) maximum threshold, or a safety net threshold, on consumer copayments for health care financed by the abolition of the Long-term Illness Regime (ALD) in France. The analysis is based on a comparison of different safety net threshold rules and their redistributive effects on patients’ OOP payments. We attach particular importance to indicators that bring to light changes in OOP payment levels and measure their impact on the equity of OOP distribution. The first section outlines the French National Health System to provide a better understanding of the stakes involved in reforming the health care reimbursement rules under the Compulsory Health Care Insurance scheme. In the second section, we describe the hypotheses retained, the database and the microsimulation model. The final section presents key findings, measuring the impact of the reform at both individual and system levels.Microsimulation, Health expenditure, Out-of-pocket payment.

Social Capital and Health of Older Europeans

This research uses a time-based approach of the causal relationship (Granger-like)between health and social capital for older people in Europe. We use panel data from waves 1 and 2 of SHARE (the Survey of Health, Ageing, and Retirement in Europe)for the analysis. Additional wave 3 data on retrospective life histories (SHARELIFE)are used to model the initial conditions in the model. For each of the first 2 waves, a dummy variable for involvement in social activities (voluntary associations, church, social clubs, etc.) is used as a proxy for social capital as involvement in Putnamesque associations; and seven health dichotomous variables are retained, covering a wide range of physical and mental health measures. A bivariate recursive Probit model is used to simultaneously investigate (i) the influence of baseline social capital on current health - controlling for baseline health and other current covariates, and (ii)the impact of baseline health on current participation in social activities - controlling for baseline social capital and other current covariates. As expected, we account for a reversed causal effect: individual social capital has a causal beneficial impact on health and vice versa. However, the effect of health on social capital appears to be significantly higher than the social capital effect on health. These results indicate that the sub-population reaching 50 years old in good health has a higher propensity to take part in social activities and to benefit from it (social support, etc.). Conversely, the other part of the population in poor health at 50, may see its health worsening faster because of the missing beneficial effect of social capital. Social capital may therefore be a potential vector of health inequalities.Healthy Ageing, Social Capital, Health Inequality, Granger Causality, Panel Data.

L’influence des conditions de travail sur les dépenses de santé

L’objectif de cette étude est d’estimer l’impact de certaines conditions de travail sur des indicateurs de dépenses de santé et de mesurer l’effet agrégé sur les dépenses de santé de la collectivité. Notre analyse empirique repose sur un échantillon de salariés âgés de 18 à 65 ; ces données sont issues de l’enquête Santé 2002-2003. Nous utilisons trois indicateurs des dépenses de santé : le nombre de recours aux médecins généralistes ou spécialistes au cours des douze derniers mois, la prise d’arrêts de travail sur une période de deux mois consécutifs, le recours à l’hôpital au cours des douze derniers mois. Nous estimons nos effets à l’aide de deux méthodes différentes : une méthode « naïve » et une méthode par appariement. Nos résultats confirment que les conditions de travail semblent bien être à l’origine d’un accroissement des dépenses de santé. Les trois formes de pénibilités retenues (pénibilité physique actuelle, pénibilité physique passée et risques psychosociaux)induisent des modifications dans la consommation ambulatoire, dans la prise d’arrêts de travail et dans les hospitalisations. De plus, nous mettons aussi en évidence un effet supplémentaire du cumul des risques professionnels sur les dépenses de santé. Ainsi selon la méthode d’estimation retenue, les individus soumis au cumul des trois risques étudiés ont entre 22,4 % et 25,1% de consultations en plus relativement aux salariés sans exposition, entre 46,3 % et 56,1% d’arrêts de travail en plus et entre 27,2 % et 35,9 % d’hospitalisation en plus.Dépenses de santé, Conditions de travail, Evaluation.

Dynamic Estimation of Health Expenditure: A new approach for simulating individual expenditure

This study compares estimates of outpatient expenditure computed with different models. Our aim is to predict annual health expenditures. We use a French panel dataset over a six year period (2000-2006) for 7112 individuals. Our article is based on the estimations of five different models. The first model is a simple two part model estimated in cross section. The other models (models 2 to 5) are estimated with selection models (or generalized tobit models). Model 2 is a basic sample selection model in cross section. Model 3 is similar to model 2, but takes into account the panel dimension. It includes constant unobserved heterogeneity to deal with state dependency. Model 4 is a dynamic sample selection model (with lagged adjustement), while in model 5, we take into account the possible heteroskedasticity of residuals in the dynamic model. We find that all the models have the same properties in the cross section dimension (distribution, probability of health care use by gender and age, health expenditure by gender and age) but model 5 gives better results reflecting the temporal correlation with health expenditure. Indeed, the retransformation of predicted log transformed expenditures in homoscedastic models (models 1 to 4) generates very poor temporal correlation for " heavy consumers ", although the data show the contrary. Incorporation of heteroskedasticity gives better results in terms of temporal correlation.Health econometrics, expenditures, panel data, selection models

Disability and social security reforms: The French case

The French pattern of early transitions out of employment is basically explained by the low age at “normal” retirement and by the importance of transitions through unemployment insurance and early-retirement schemes before access to normal retirement. These routes have exempted French workers from massively relying on disability motives for early exits, contrarily to the situation that prevails in some other countries where normal ages are high, unemployment benefits low and early-retirement schemes almost non-existent. Yet the role of disability remains interesting to examine in the French case, at least for prospective reasons in a context of decreasing generosity of other programs. The study of the past reforms of the pension system underlines that disability routes have often acted as a substitute to other retirement routes. Changes in the claiming of invalidity benefits seem to match changes in pension schemes or controls more than changes in such health indicators as the mortality rates. However, our results suggest that increases in average health levels over the past two decades have come along with increased disparities. In that context, less generous pensions may induce an increase in the claiming of invalidity benefits partly because of substitution effects, but also because the share of people with poor health increases.pensions ; social security ; disability ; early retirement ; unemployment ; senior

Disability and Social Security Reforms:The French Case

The French pattern of early transitions out of employment is basically explained by the low age at “normal” retirement and by the importance of transitions through unemployment insurance and early-retirement schemes before access to normal retirement. These routes have exempted French workers from massively relying on disability motives for early exits, contrarily to the situation that prevails in some other countries where normal ages are high, unemployment benefits low and early-retirement schemes almost non-existent. Yet the role of disability remains interesting to examine in the French case, at least for prospective reasons in a context of decreasing generosity of other programs. The study of the past reforms of the pension system underlines that disability routes have often acted as a substitute to other retirement routes. Changes in the claiming of invalidity benefits seem to match changes in pension schemes or controls more than changes in such health indicators as the mortality rates. However, our results suggest that increases in average health levels over the past two decades have come along with increased disparities. In that context, less generous pensions may induce an increase in the claiming of invalidity benefits partly because of substitution effects, but also because the share of people with poor health increases.Pensions, Social Security, Disability, Early Retirement, Unemployment, Senior.

Crise et déficit de l’assurance maladie:Faut-il changer de paradigme ?

Le déficit de l’assurance maladie, de l’ordre de 1 point de PIB, résulte pour l’essentiel de la crise économique qui a réduit les recettes de cotisations sociales et de CSG. Ce déficit concoure à la stabilisation automatique de l’économie et il devrait se résorber avec le retour de la croissance. Tant que celle-ci n’est pas revenue, la résorption volontaire du déficit par la hausse des prélèvements ou la baisse des dépenses serait contra-cyclique et doit être écartée. Mais, une part du déficit, que l’on peut évaluer entre 0,35 et 0,7 point de PIB, résulte de l’existence d’un écart structurel entre la croissance des dépenses de santé et celle du PIB. Pour une bonne gestion à long terme de l’assurance maladie, il est nécessaire d’éliminer ce déficit structurel, évalué entre 1,4 et 2,8 points de PIB si rien n’est fait en 2020. Jusqu’alors celui-ci a été contenu par un mixte de hausse des prélèvements affectés au financement de l’assurance maladie et un baisse des taux de remboursement. La recherche d’une meilleure maîtrise des dépenses par un changement de l’organisation du système de soin (exercice collectif de la médecine favorisant complémentarité et substitution entre professions ; construction d’un système intégrant mieux l’ambulatoire et l’hôpital,...) ainsi qu’une réforme des modes de financement (réduction de la part du paiement à l’acte) permettant de réduire les inégalités d’accès aux soins (en particulier celles liées aux dépassements d’honoraires) mériteraient d’être discutées dans le cadre des débats sur l’évolution des dépenses de santé et de leur financement.The deficit of health insurance, about 1 percentage point of GDP mainly results from the economic crisis which reduced social contributions. This deficit contributes to the automatic stabilization of the economy and it should disappear with the return of growth. As far as it is not returned, the voluntary reduction of the deficit, rising levies or lower spending, would be counter-cyclical and must be rejected. But part of the deficit, we evaluate between 0.35 and 0.7 percent of GDP, results from the existence of a structural gap between growth in health spending and growth in GDP. For a good long-term management of health insurance, it is necessary eliminate the structural deficit, evaluated between 1.4 and 2.8 percent of GDP in 2020 without structural evolution. Hitherto it has been contend by a combination of taxes increase and reduction of reimbursement rate. The search for a better control of expenditure founded on a change in the organization of care (more collective exercise promoting complementary medicine and alternative between professions, building of a new system integrating best the ambulatory and hospital, ...) and a reform of the modes of financing (with more per capita remuneration for the physicists) for reduce inequalities in access to care would be worth discussed in the context of discussions on the spending trend health and their financing

Health status, Neighbourhood effects and Public choice: Evidence from France

Observation of socioeconomic statistics between different neighbourhoods highlights significant differences for economic indicators, social indicators and health indicators. The issue faced here is determining the origins of health inequalities: individual effects and neighbourhood effects. Using National Health Survey and French census data from the period 2002-2003, we attempt to measure the individual and collective determinants of Self-Reported Health Status (SRH). By using a principal component analysis of aggregated census data, we obtain three synthetic factors called: "economic and social condition", "mobility" and "generational" and show that these contextual factors are correlated with individual SRHs. Since the 80s, different French governments have formulated public policies in order to take into account the specific problems of disadvantaged and deprived neighbourhoods. In view to concentrating national assistance, the French government has created "zones urbaines sensibles" (ZUS) [Critical Urban Areas, CUA]. Our research shows that in spite of implementing public policy in France to combat health inequalities, by only taking into account the CUA criterion (the fact of being in a CUA or not), many inequalities remain ignored and thus hidden.Health, Neighbourhood Effect, Housing policy