The shape of the relationship between mortality and income in France.

Cette recherche explore la forme de relation existante entre probabilité de décès et revenu en France, sur la base d’une étude cas-témoins constituée à partir de deux bases de données fiscales. Les résultats montrent que le risque de décès est fortement corrélé au niveau de revenu, après contrôle par la profession. Cette relation existe tout au long de la distribution des revenus. En particulier , l’effet protecteur des plus hauts revenus remet en cause l’hypothèse de concavité de la relation revenu-santé.Using a case-control study constructed with two fiscal databases, this paper investigates the shape of the relationship between income and the probability of death in France. The results show that the risk of mortality is strongly correlated with the level of income, independent from the occupational status. This relationship holds across the whole range of income distribution. Specifically the protective effect of highest incomes casts some doubt on the hypothesis of the concavity of the income-health relationship.Mortality; Health inequalities; Income;

Monitoring Health Inequalities in France: A Short Tool for Routine Health SUrvey to Account for LifeLong Adverse Experiences

Conventional health surveys focus on current health and social context but rarely address past experiences of hardship or exclusion. However, recent research shows how such experiences contribute to health status and social inequalities. In order to analyse in routine statistics the impact of lifelong adverse experiences (LAE) on various health indicators, a new set of questions on financial difficulties, housing difficulties due to financial hardship and isolation was introduced in the 2004 French National health, health care and insurance survey (ESPS 2004). Logistic regressions were used to analyze associations between LAE, current socioeconomic status (SES) (education, occupation, income) and health (self-perceived health, activity limitation, chronic morbidity), on a sample of 4308 men and women aged 35 years and older. In our population, LAE were reported by 1 person out of 5. Although more frequent in low SES groups, they concerned above 10% of the highest incomes. For both sexes, LAE are significantly linked to poor self-perceived health, diseases and activity limitations, even controlling for SES (OR>2) and even in the highest income group. This pattern remains significant for LAE experienced only during childhood. The questions successfully identified in a conventional survey people exposed to health problems in relation to past experiences. LAE contribute to the social health gradient and explain variability within social groups. These questions will be useful to monitor health inequalities, for instance by further analyzing LAE related health determinants such as risk factors, exposition and care use.Health inequalities; Lifelong adverse experiences; Health surveys

Psychosocial resources and social health inequalities in France: Exploratory findings from a general population survey

We study the psychosocial determinants of self-assessed health in order to explain social inequalities in health in France. We use a unique general population survey to assess the respective impact on self-assessed health status of subjective perceptions of social capital, social support, and sense of control, controlling for standard socio-demographic factors (SES, income, education, age and gender). The survey is unique in that it provides a variety of measures of self-perceived psychosocial resources (trust and civic engagement, social support, sense of control, and self-esteem. We find empirical support for the link between the subjective perception of psychosocial resources and health. Sense of control at work is the most important correlate of health status after income. Other important ones are civic engagement and social support. To a lesser extent, sense of being lower in the social hierarchy is associated with poorer health status. On the contrary, relative deprivation does not affect health in our survey. Since access to psychosocial resources is not equally distributed in the population, these findings suggest that psychosocial factors can partially explain of social inequalities in health in France.social capital, social support, relative deprivation, sense of control, social health inequalities, France

Psychosocial resources and social health inequalities in France: Exploratory findings from a general population survey

We study the psychosocial determinants of health, and their impact on social inequalities in health in France. We use a unique general population survey to assess the respective impact on selfassessed health status of subjective perceptions of social capital controlling for standard socio-demographic factors (occupation, income, education, age and gender). The survey is unique for two reasons: First, we use a variety of measures to describe self-perceived social capital (trust and civic engagement, social support, sense of control, and selfesteem). Second, we can link these measures of social capital to a wealth of descriptors of health status and behaviours. We find empirical support for the link between the subjective perception of social capital and health. Sense of control at work is the most important determinant of health status. Other important ones are civic engagement and social support. To a lesser extent, sense of being lower in the social hierarchy is associated with poorer health status. On the contrary, relative deprivation does not affect health in our survey. Since access to social capital is not equally distributed in the population, these findings suggest that psychosocial factors can explain a substantial part of social inequalities in health in France.social capital, social support, relative deprivation, sense of control, social health inequalities, France

Impact of health care system on socioeconomic inequalities in doctor use

This study examines the impact of health system characteristics on social inequities in health care use in Europe, using data from national surveys in 13 European countries. Multilevel logistic regression models are estimated to separate the individual level determinants of generalist and specialist use from the health system level and country specific factors. The results suggest that beyond the division between public and private funding and cost-sharing arrangements in health system, the role given to the general practitioners and/or the organization of the primary care might be essential for reducing social inequities in health care utilisation.Equity, Health system, Doctor utilisation, Multilevel, International

Social health inequalities : a French analysis based on the migrant population.

Using a representative survey of the French population, the Health, Health Care and Insurance Survey (ESPS: “Enquête sur la santé et la protection sociale”), this article aims to study the links between migration, region of origin and health status in France. Firstly, we have compared the health status between migrants and the native population in discerning an identifiable difference between first-generation and second-generation migrants. Following this, in order to explain the heterogeneity of health status amongst the migrant population, we have refined our analysis by integrating their country of origin into our estimation and then exploring the health differences between individuals who have emigrated from South-East Mediterranean (SEM) countries and individuals who have emigrated from all other countries. Our findings show that there exist health inequalities that are related to immigration, when compared with the health status of the native population in France. First and second generation migrants have a higher risk than the native French born population to report a poor health status. By introducing country of origin into our analysis we are able to confirm the health heterogeneity within both groups of migrants. Individuals coming from SEM countries are more likely to report poor health status than the native French born population (for both generation migrants) and this risk seems significantly higher for individuals who have emigrated from Turkey. These inequalities are partly explained by the poor socio-economic conditions of the migrant population and a general lack of social integration in France.Health Care; Immigration; France;

Affordability of complementary health insurance in France : a social experiment.

In order to improve financial access to complementary health insurance (CHI) in France, a CHI voucher program, called Aide Complémentaire Santé (ACS) was introduced in 2005. Four years later, the program covered only 18% of the eligible population. Two main hypotheses are put forward to account for this low take-up rate. The first one is related to the lack of information on the program itself and on its application process. While the second one considers that the amount of the financial support is too small to encourage people to purchase a CHI plan. We conduct a controlled experiment with the National Health Insurance Fund in order to assess these assumptions. A sample of eligible insurees living in an urban area in northern France were randomly split into three groups: a control group who received the standard level of financial aid, a group benefiting from a 75% voucher increase, and a third group benefiting from the same 75% voucher increase plus an invitation to an information meeting on ACS. After six months of follow-up, we observed how many application forms were sent back and how many of them entitled to ACS. Five main conclusions can be drawn from that analysis. (1) The voucher increase has a slight but statistically significant effect on ACS take-up. (2) It also allows better targeting of people actually eligible and thus reduces the number of ACS refusals due to resources above the upper limit. (3) However the invitation to the meeting seems unexpectedly to cancel the positive effect of the voucher increase when both treatments are applied jointly. (4) On the contrary, after controlling for potential selection bias, we observed that attending the briefing has a significant impact on ACS take-up. (5) This study confirms that ACS is complex and reaches poorly its target population. Only 17% of the insurees applied for ACS and only 9% of insures who were invited to the information briefing actually attended it. Moreover, previous CHI holders responded similarly to CHI non holders to treatments, which suggests that the central issue of ACS low take-up rate is not the CHI cost itself but most certainly the access to information, the burden and the complexity of the application process.France; Subsidized Health insurance; low-income population; uninsured; randomized experiment;

The Likely Effects of Employer-Mandated Complementary Health Insurance on Health Coverage in France

In France, access to health care greatly depends on having a complementary health insurance coverage (CHI). Thus, the generalisation of CHI became a core factor in the national health strategy created by the government in 2013. The first measure has been to compulsorily extend employer-sponsored CHI to all private sector employees on January 1st, 2016 and improve its portability coverage for unemployed former employees for up to 12 months. Based on data from the 2012 Health, Health Care and Insurance survey, this article provides a simulation of the likely effects of this mandate on CHI coverage and related inequalities in the general population by age, health status, socio-economic characteristics and time and risk preferences. We show that the non-coverage rate that was estimated to be 5% in 2012 will drop to 4% following the generalisation of employer-sponsored CHI and to 3.7% after accounting for portability coverage. The most vulnerable populations are expected to remain more often without CHI whereas non coverage will significantly decrease among the less risk averse and the more present oriented. With its focus on private sector employees, the policy is thus likely to do little for populations that would benefit most from additional insurance coverage while expanding coverage for other populations that appear to place little value on CHI

The Consequences of unmet Health Care Needs during the first Wave of the Covid-19 Pandemic on Health

The first wave of the covid-19 pandemic led many people to have unmet health care needs, which could have detrimental effects on their health. This paper addresses the question of the effect of unmet needs during the first wave of the pandemic on health outcomes up to one year after. We combine two waves of the SHARE survey collected during the covid-19 pandemic (in June/July 2020 and 2021), as well as two waves collected before the pandemic. Our health outcomes are four dummy variables for having troubles with fatigue, falling, fear of falling and dizziness/faints/blackouts issues. Finally, we use an OLS regression with individual and time fixed effects for our difference-indifference analysis, as well as a doubly robust estimator to condition the parallel trend assumption on pre-pandemic covariates. We find substantial short-term effects on the probability of having troubles with fatigue and dizziness. We additionally observe that one year later, June/July 2021, having had unmet health care needs in 2020 increased the probability of having troubles for each of the health measures. We particularly find strong effects for general practitioner (GP) and specialist care

Social heterogeneity in self-reported health status and measurement of inequalities in health

This study aims to analyse the impact of the measurement of health status on socioeconomic inequalities in health. A MIMIC model with structural equations is used to create a latent variable of health status from four health indicators: self-assessed health, report of chronic diseases, report of activity limitations and mental health. Then, we disentangle the impact of sociodemographic characteristics on latent health from their direct impact on each heath indicator and discuss their effects on the assessment of socioeconomic inequalities in health. This study emphasises differences in inequalities in health according to latent health. In addition, it suggests the existence of reporting heterogeneity biases. For a given latent health status, women and old people are more likely to report chronic diseases. Mental health problems are over-reported by women and isolated people and under-reported by the oldest people. Active and retired people as well as non manual workers in the top of the social hierarchy more often report activity limitations. Finally, highly educated and socially advantaged people more often report chronic diseases whereas less educated people under-report a poor self-assessed health. To conclude, the four health indicators suffer from reporting heterogeneity biases and the report of chronic diseases is the indicator which biases the most the measurement of socioeconomic inequalities in health.inequalities in health - MIMIC - reporting bias - structural equations