health status and health care use of migrants in france irdes · 2015-01-29 · health status and...

Health status and health care use of migrants in France

IRDES

Paul Dourgnon (IRDES & LEDa-LEGOS, Paris Dauphine University ) with

Caroline Berchet (LEDa-LEGOS, Paris Dauphine University )

Florence Jusot (LEDa-LEGOS, Paris Dauphine University & IRDES)

Catherine Sermet (IRDES)

1

Context

Inequalities in health and health care use between social groups have been well

documented in France within last 10 years

Comparative studies (Ecuity and Eurothine projects) have shown that

inequalities in health and health care use are particularly important in France in

comparison with other European countries

Very few studies have focused on health status and access to health care of

foreign and migrant populations in France

Whereas migrant’s health status and access to care should be a genuine public

health concern considering

Several pathways could explain differences in health status and in health care

use between migrants population and natives

1

Looking for causal pathways from Migration to Health

Migration effects

Healthy migrant effect: selection at migration

Isolation and loss of social networks

Migrants socioeconomic status and working conditions

Lower socioeconomic status and poor working conditions, due to:

Poor human capital transferability, discrimination

Difficulties to access job market due to legal context

Difficulties to access health care system

Difficulties to access health care system due to legal context and poor SES (lowhealth insurance coverage)

Informational barriers, language gap, interactions with health system

Country of origin Heterogeneity:

Differences in health-related behaviours / health care utilisation habits

Long term effect of the economic and sanitary conditions of the country of origin

1

Data

The lack of study focussing on migrants population is largely explained by the lack of

information on nationality and country of birth in most of health surveys

As data provider, IRDES has had the opportunity to explore this issue based on two

French national health surveys (22 individuals each) which regularly provide accurate

information on health status and health care use :

the Decennial Survey on Health and Health Care conducted by INSEE in collaboration

with IRDES :

the wave 2002/2003 provides information on the nationality and the country of

birth of the respondents

the Survey of Health, Health care and Insurance carried out by IRDES

the waves 2006, 2008 and 2010 have been partly designed in order to collect data

on the nationality and the country of birth of the respondents, as well as the

nationality and the country of birth of theirs parents (to distinguish the first and the

second generations of migrants)

1

Analytic strategy of IRDES studies

Descriptive point of view

To provide evidence on the difference in health status and access to care between

migrants population and native population in France

According to the country of origin (among which NA) and migrant’s duration of stay

Explicative point of view

To distinguish the direct migration effects on health status from the influence of

migrant’s socioeconomic status, lifestyles and social capital

To explore the heterogeneity of health status among countries of birth and explain it by a

long term effect of socioeconomic conditions experienced in the country of origin

To distinguish the direct migration effects on health care use from the influence of

migrant’s socioeconomic status and access to health insurance

1

Health status and Health care use measurement

Health status measurement

Self-assessed health

«How is your health in general ? » very good ; good / average ; poor ; very

poor

Self-reported chronic diseases

Self-reported activity limitations

Health care use measurement

Use of GP care during the last 12 months (0/1)

Number of GP visits during the last 12 months

Use of specialist care during the last 12 months (0/1)

Number of specialists visits during the last 12 months

Inpatient care during the last 12 months (0/1)

1

Publications

Based on the 2002-2003 Decennial Survey on Health

Paul Dourgnon, Florence Jusot, Catherine Sermet, Jérôme Silva (2008), “The self-assessed health

status of immigrants in France : an analysis of the 2002-2003 decennial health survey”, Issues in

Health Economics, 133.

Paul Dourgnon, Florence Jusot, Catherine Sermet, Jérôme Silva (2009), “Immigrants’ Access to

Ambulatory Care in France”, Issues in Health Economics, 146.

Jusot Florence, Silva Jérôme, Dourgnon Paul, Sermet Catherine (2009), "Inégalités de santé liées à

l'immigration en France : effet des conditions de vie ou sélection à la migration ? “, Revue

Economique, Revue Economique, 60, 2 : 385-411.

Based on the 2006 Survey of Health, Health care and Insurance

Berchet C., Jusot F. (2009), "Inégalités de santé liées à l’immigration et capital social : une analyse en

décomposition", Economie Publique, 24-25, 1-2 : 73-100.

Berchet C., Jusot F. (2010), L’état de santé des migrants de première et de seconde génération en

France. Une analyse selon le genre et l’origine, Revue Economique, 61, 6 : 1075-1098.

Situation of Migrants in France

2

Migrants population in France

Foreign population (individuals born non French abroad, with current foreign

nationality) = 8.3% of the population living in France in 2007

Second generation of migrants (individuals born from at least one parent born

non French abroad) = 11 % of the population living in France in 2008

2

Migrants in France

Most of migrants are from North Africa (Algeria, Morocco, Tunisia) andSouthern Europe, as well as the large majority of migrants’ children (secondgeneration of migrants)

Health status of migrants in France

Paul Dourgnon, Florence Jusot, Catherine Sermet, Jérôme Silva

(2008), “The self-assessed health status of immigrants in France

: an analysis of the 2002-2003 decennial health survey”, Issues

in Health Economics, 133

1

Worse self-assessed health status

Probability of reporting a poor

health status

Adjusted for age and sexAdjusted for age, sex, and

SES

Odds ratio p-value Odds ratio p-value

French national born in France Ref. - Ref. -

Naturalized immigrant 1.57 <0.001 1.42 <0.001

Foreign immigrant 1.74 <0.001 1.26 0.001

Differences in SAH are partially explained by the poor socioeconomic statusand the bad working conditions of migrants in France Other French studies also show role of social capital and lifestyles

Heterogeneity according to country of origins

Migrants from North Africa report poorer health status than natives and migrantsfrom richer countriesDifferences between countries of origin are largely explained by their economic andsanitary conditions

Region of birth

Adjusted for age

and sex

Adjusted for age,

sex and SES

O.R. p-value O.R. p-value

France and French overseas territories Ref. - Ref -

Northern Europe 0.49 <0.001 0.59 0.008

Central Europe 1.61 0.015 1.35 0.141

Southern Europe 1.91 <0.001 1.49 <0.001

Turkey 2.07 0.007 1.43 0.188

North Africa 2.41 <0.001 1.58 <0.001

Middle East 0.79 0.48 0.95 0.89

sub-Saharan Africa 1.5 0.043 1.13 0.558

Indian sub-continent + islands 1.61 0.126 1.09 0.786

Asia 1.53 0.027 1.42 0.079

America, Australia, New Zealand 0.66 0.202 0.85 0.621

Heterogeneity according to country of birth

Differences between country of origin are partially explained by the economic andsanitary conditions of the country of origin : in comparison with more advantagedcountries, migrants from intermediate countries are more likely to report poor healthstatus

Country of birth characteristics

Adjusted for age, sex

and SES

O.R. p-value

Less developed countries (First quintile of GDP) 1.3 0.188

Moderately developed countries (Q2 of GDP) 1.58 0.001

Advantaged countries (Q3 of GDP) 1.71 <0.001

More Advantaged countries (Q4 of GDP) Ref. -

Health care use of migrants in France

Paul Dourgnon, Florence Jusot, Catherine Sermet,

Jérôme Silva (2009), “Immigrants’ Access to

Ambulatory Care in France”, Issues in Health

Economics, 146.

Impact of migration status on health care utilization

Probability of use

Control variables Model 1 Model 2 Model 3

Age, Sex, health status

SES

Health insurance

Impact of migration status(Ref : French born French) OR OR OR

GP care

Foreign Immigrant 0,78*** 0,92 1,12

Naturalized Immigrant 0,83* 0,92 1

Specialist care

Foreign Immigrant 0,66*** 0,93** 0,93

Naturalized Immigrant 0,96 1,04 1,1

Hospitalizations

Foreign Immigrant 0,85* 0,83* 0,87


Impact of migration status on level of health care use

Log of visits number



SES

Health insurance

Impact of migration status(Ref : French born French) Coef. Coef. Coef.

GP care

Foreign Immigrant -0,038* -0,079*** -0,056**

Naturalized Immigrant -0,031 -0,051 -0,039

Specialist care

Foreign Immigrant -0,052* -0,022 -0,001


Heterogeneity of health care use according to country of birth

Probability of health care use

GP Specialist

Control variables


SES

Health insurance

Impact of country of birth(Ref : France)

Northern Europe 0,92 1,16 0,77* 0,64**

Central Europe 0,66 0,91 0,8 0,97

Southern Europe 0,82 0,9 0,92 1,18

Turkey 0,67 1,07 0,55** 0,93

North Africa 0,98 1,46*** 0,73*** 1,14

Middle East 0,44*** 0,62 1,13 1,11

sub-Saharan Africa 0,73 1,18 0,67** 0,99

Indian sub-continent + islands 0,59 0,91 0,34*** 0,51**

Asia 0,52*** 0,73 0,58** 0,72

America, Australia, New Zealand 0,84 1,24 0,86 0,78

Conclusion and next steps for research on health care use of

migrants in France

1

Conclusions of previous studies

Health Status

Migrants have a poorer self-assessed health status than French natives, in

particular Migrants from North Africa

Those differences are explained by :

the poor socioeconomic status of migrants in France and their poor workingconditions

their lack of integration and their unhealthy lifestyles

a long term effect of country of origin characteristics

Health care utilisation

Migrants have a lower probability of health care use

Because of worse SES

Because of a poorer access to health insurance

When they use the health care system, foreign migrants have a lower number

of visits after adjustment for needs, SES and health insurance coverage

1

Aims of future studies


More evidence on the difference in health status and access to care between

migrants population and native population in France :

for others dimensions of health status : mental health

with better descriptors of health care use (adminitrative data from the

National Health Insurance Fund )

according to the country of origin distinguishing countries from North

Africa


To deepen the study of the role of access to health insurance

To evaluate the impact on health status and health care of specific public

insurance proposed to migrant population

Immigrants in France

Paul Dourgnon (IRDES & LEDa-LEGOS, Paris Dauphine University )



1

Immigrants, foreigners, naturalized

8.3% of French population = 5.2 millions (2007)

1

A century of immigration (1)

More than one million immigrants at the beginning of 20th century (3% total

population)

Pro immigration policies (gov agencies and NGOs)

After WWI till 29 crisis

After WWII to 1973

6.6% in 1930

7.5% in 1975

8.3% in 2007

1


Before WWI: mostly neighbouring countries (Italy, Belgium...)

After WWI:

Along the 20’s : Spain, Italy, Eastern Europe (Poland +++)

Armenians, Russians following Russian revolution and Armenian genocide

After 1936: Spanish republicans

After WWII

Portugal, Maghreb, Sub-Saharian Africa, South-East Asia

European immigrants: 78.7% in 1962 44.9% in 1999

NA immigration starts around 1910

1


1

Workers, family members, refugees and students

1

Immigrants SES in France (1)

1


1


15% of immigrants below poverty line

(20% among Maghreb immigrants)

Vs. 6% general population

IRDES & EUNAMHow we plan to participate




1

(WP1) Health, biological and psycho-social well being of NA migrants in EU

compared with natives and other immigrants groups

(Irdes = 5) Irdes describes the situation in France year 2

SAH : QES santé migrants + second generation, with a focus on NA (France)

Mental health ESPS, HSM 2008 (possibility for Iresp call) with focus on NA (France)

Social capital: migrants vs. aboriginals, with focus on NA, and second generation (done?)

Health behaviors: migrants vs. aboriginals, with focus on NA, and second generation

2 months research director + research fellow (12 months), Total 14 months

(WP3) Health care utilization by immigrants compared to natives

(IRDES= 20: coordination, describes the situation in France year 1EU-NA situation summarized in year

4)

WP Coordination

Access to Health care

- Discrimination

Evidence review

- Unmet needs

France, EU comparison if possible

- Health services utilization

Migrants vs. aboriginals, with focus on NA, and second generation, European comparison if possible

Ambulatory care, hospital care, preventive care

Access to health insurance

- Migrants vs. aboriginals, with focus on NA, and second generation (France, EU maybe)

- Evaluation of impact of specific migrants health insurance programs (France: AME)

Impact of migrants financial transfers on access to health care and insurance in the country of origin

(???)

10 months senior research fellow, 12 months research fellow, Total 22 months

1

(WP4) Population well being and health care in NA with time trends (IRDES=5 : French experience years 3 and 4)

France helps on methodology and econometric workframe if needed, from WP1 and WP3

Coordinator: XX

Team XX

2 months senior or junior research fellow

(WP6) Lessons for prevention in NA, EU and the world (EUNAM results synthesis?)

2 months ??

(WP7) Knowledge and skills n health studies related to immigrants are

advanced through training, information transfer and outlining of research

and policy targets

(IRDES= 5 training and policy recommendations)

5 months ??

IRDESInstitute for research and

documentation in health economics

Paul Dourgnon

Marie Lenormand

2

Who we are

IRDES created back in 1988

IRDES is a pluri-disciplinary structure in

-Economics

-Statistics

-Public Health

75 % funding come from main sickness funds

25% funding come from call for tenders

3

What we do

-Academic research and expertise

For research community

For institutions

-Data production

Data base « Eco-santé » (statistical series on health, health

expenditure, medical demography, medical activities)

General population surveys (ESPS, PSCE, EHIS, SHARE)

Microdata

Representative

Longitudinal

International

4

• Health Care System

Outpatient and inpatient care supply

Organisation, efficiency, quality, practice variations

• Health insurance

Compulsory and complementary insurance

Means tested complementary insurance

Health public expense prospective (microsimulation)

• Health and work

Health at work

Health and retirement

• Ageing and long-term care

IRDES research fields (1)

5


• Equity and access to health care

Social health inequalities

Access to health services and insurance

Health and place

Equity in fundings and redistribution

EUNAM project at IRDES part of equity and access

to health care streams of research

• International comparisons

• Public policy evaluation

6

IRDES as part of international networks

• IRDES takes part in many European research

projects and networks

EHPG, Interlinks, Era-age, Euro-reach, Eunam…

• IRDES conducts European surveys

SHARE – Survey of Health Ageing and Retirement in

Europe (since 2002)

EHIS – European Health Interview Survey in 2014 and

onwards

7

If you want to know more about IRDES

http://www.irdes.fr/EspaceAnglais/home.html

We will be happy to welcome you in Paris for a

EUNAM meeting

Last but not least…


Health status and health care use of migrants in France

IRDES

Paul Dourgnon (IRDES & LEDa-LEGOS, Paris Dauphine University ) with

Caroline Berchet (LEDa-LEGOS, Paris Dauphine University )



1

Context

Inequalities in health and health care use between social groups have been well

documented in France within last 10 years

Comparative studies (Ecuity and Eurothine projects) have shown that

inequalities in health and health care use are particularly important in France in

comparison with other European countries

Very few studies have focused on health status and access to health care of

foreign and migrant populations in France

Whereas migrant’s health status and access to care should be a genuine public

health concern considering

Several pathways could explain differences in health status and in health care

use between migrants population and natives

1

Looking for causal pathways from Migration to Health

Migration effects

Healthy migrant effect: selection at migration

Isolation and loss of social networks

Migrants socioeconomic status and working conditions

Lower socioeconomic status and poor working conditions, due to:

Poor human capital transferability, discrimination

Difficulties to access job market due to legal context

Difficulties to access health care system

Difficulties to access health care system due to legal context and poor SES (lowhealth insurance coverage)

Informational barriers, language gap, interactions with health system

Country of origin Heterogeneity:

Differences in health-related behaviours / health care utilisation habits

Long term effect of the economic and sanitary conditions of the country of origin

1

Data

The lack of study focussing on migrants population is largely explained by the lack of

information on nationality and country of birth in most of health surveys

As data provider, IRDES has had the opportunity to explore this issue based on two

French national health surveys (22 individuals each) which regularly provide accurate

information on health status and health care use :

the Decennial Survey on Health and Health Care conducted by INSEE in collaboration

with IRDES :

the wave 2002/2003 provides information on the nationality and the country of

birth of the respondents

the Survey of Health, Health care and Insurance carried out by IRDES

the waves 2006, 2008 and 2010 have been partly designed in order to collect data

on the nationality and the country of birth of the respondents, as well as the

nationality and the country of birth of theirs parents (to distinguish the first and the

second generations of migrants)

1

Analytic strategy of IRDES studies


To provide evidence on the difference in health status and access to care between

migrants population and native population in France

According to the country of origin (among which NA) and migrant’s duration of stay


To distinguish the direct migration effects on health status from the influence of

migrant’s socioeconomic status, lifestyles and social capital

To explore the heterogeneity of health status among countries of birth and explain it by a

long term effect of socioeconomic conditions experienced in the country of origin

To distinguish the direct migration effects on health care use from the influence of

migrant’s socioeconomic status and access to health insurance

1

Health status and Health care use measurement

Health status measurement

Self-assessed health

«How is your health in general ? » very good ; good / average ; poor ; very

poor

Self-reported chronic diseases

Self-reported activity limitations

Health care use measurement

Use of GP care during the last 12 months (0/1)

Number of GP visits during the last 12 months

Use of specialist care during the last 12 months (0/1)

Number of specialists visits during the last 12 months

Inpatient care during the last 12 months (0/1)

1

Publications

Based on the 2002-2003 Decennial Survey on Health

Paul Dourgnon, Florence Jusot, Catherine Sermet, Jérôme Silva (2008), “The self-assessed health

status of immigrants in France : an analysis of the 2002-2003 decennial health survey”, Issues in

Health Economics, 133.

Paul Dourgnon, Florence Jusot, Catherine Sermet, Jérôme Silva (2009), “Immigrants’ Access to

Ambulatory Care in France”, Issues in Health Economics, 146.

Jusot Florence, Silva Jérôme, Dourgnon Paul, Sermet Catherine (2009), "Inégalités de santé liées à

l'immigration en France : effet des conditions de vie ou sélection à la migration ? “, Revue

Economique, Revue Economique, 60, 2 : 385-411.

Based on the 2006 Survey of Health, Health care and Insurance

Berchet C., Jusot F. (2009), "Inégalités de santé liées à l’immigration et capital social : une analyse en

décomposition", Economie Publique, 24-25, 1-2 : 73-100.

Berchet C., Jusot F. (2010), L’état de santé des migrants de première et de seconde génération en

France. Une analyse selon le genre et l’origine, Revue Economique, 61, 6 : 1075-1098.

Situation of Migrants in France

2

Migrants population in France

Foreign population (individuals born non French abroad, with current foreign

nationality) = 8.3% of the population living in France in 2007

Second generation of migrants (individuals born from at least one parent born

non French abroad) = 11 % of the population living in France in 2008

2

Migrants in France

Most of migrants are from North Africa (Algeria, Morocco, Tunisia) andSouthern Europe, as well as the large majority of migrants’ children (secondgeneration of migrants)

Health status of migrants in France

Paul Dourgnon, Florence Jusot, Catherine Sermet, Jérôme Silva

(2008), “The self-assessed health status of immigrants in France

: an analysis of the 2002-2003 decennial health survey”, Issues

in Health Economics, 133

1

Worse self-assessed health status

Probability of reporting a poor

health status

Adjusted for age and sexAdjusted for age, sex, and

SES

Odds ratio p-value Odds ratio p-value

French national born in France Ref. - Ref. -

Naturalized immigrant 1.57 <0.001 1.42 <0.001

Foreign immigrant 1.74 <0.001 1.26 0.001

Differences in SAH are partially explained by the poor socioeconomic statusand the bad working conditions of migrants in France Other French studies also show role of social capital and lifestyles

Heterogeneity according to country of origins

Migrants from North Africa report poorer health status than natives and migrantsfrom richer countriesDifferences between countries of origin are largely explained by their economic andsanitary conditions

Region of birth

Adjusted for age

and sex

Adjusted for age,

sex and SES

O.R. p-value O.R. p-value

France and French overseas territories Ref. - Ref -

Northern Europe 0.49 <0.001 0.59 0.008

Central Europe 1.61 0.015 1.35 0.141

Southern Europe 1.91 <0.001 1.49 <0.001

Turkey 2.07 0.007 1.43 0.188

North Africa 2.41 <0.001 1.58 <0.001

Middle East 0.79 0.48 0.95 0.89

sub-Saharan Africa 1.5 0.043 1.13 0.558

Indian sub-continent + islands 1.61 0.126 1.09 0.786

Asia 1.53 0.027 1.42 0.079

America, Australia, New Zealand 0.66 0.202 0.85 0.621

Heterogeneity according to country of birth

Differences between country of origin are partially explained by the economic andsanitary conditions of the country of origin : in comparison with more advantagedcountries, migrants from intermediate countries are more likely to report poor healthstatus

Country of birth characteristics

Adjusted for age, sex

and SES

O.R. p-value

Less developed countries (First quintile of GDP) 1.3 0.188

Moderately developed countries (Q2 of GDP) 1.58 0.001

Advantaged countries (Q3 of GDP) 1.71 <0.001

More Advantaged countries (Q4 of GDP) Ref. -

Health care use of migrants in France

Paul Dourgnon, Florence Jusot, Catherine Sermet,

Jérôme Silva (2009), “Immigrants’ Access to

Ambulatory Care in France”, Issues in Health

Economics, 146.

Impact of migration status on health care utilization

Probability of use



SES

Health insurance

Impact of migration status(Ref : French born French) OR OR OR

GP care

Foreign Immigrant 0,78*** 0,92 1,12

Naturalized Immigrant 0,83* 0,92 1

Specialist care

Foreign Immigrant 0,66*** 0,93** 0,93


Hospitalizations

Foreign Immigrant 0,85* 0,83* 0,87


Impact of migration status on level of health care use

Log of visits number



SES

Health insurance

Impact of migration status(Ref : French born French) Coef. Coef. Coef.

GP care

Foreign Immigrant -0,038* -0,079*** -0,056**


Specialist care

Foreign Immigrant -0,052* -0,022 -0,001


Heterogeneity of health care use according to country of birth

Probability of health care use

GP Specialist

Control variables


SES

Health insurance

Impact of country of birth(Ref : France)

Northern Europe 0,92 1,16 0,77* 0,64**

Central Europe 0,66 0,91 0,8 0,97

Southern Europe 0,82 0,9 0,92 1,18

Turkey 0,67 1,07 0,55** 0,93

North Africa 0,98 1,46*** 0,73*** 1,14

Middle East 0,44*** 0,62 1,13 1,11

sub-Saharan Africa 0,73 1,18 0,67** 0,99

Indian sub-continent + islands 0,59 0,91 0,34*** 0,51**

Asia 0,52*** 0,73 0,58** 0,72

America, Australia, New Zealand 0,84 1,24 0,86 0,78

Conclusion and next steps for research on health care use of

migrants in France

1

Conclusions of previous studies

Health Status

Migrants have a poorer self-assessed health status than French natives, in

particular Migrants from North Africa

Those differences are explained by :

the poor socioeconomic status of migrants in France and their poor workingconditions

their lack of integration and their unhealthy lifestyles

a long term effect of country of origin characteristics

Health care utilisation

Migrants have a lower probability of health care use

Because of worse SES

Because of a poorer access to health insurance

When they use the health care system, foreign migrants have a lower number

of visits after adjustment for needs, SES and health insurance coverage

1

Aims of future studies


More evidence on the difference in health status and access to care between

migrants population and native population in France :

for others dimensions of health status : mental health

with better descriptors of health care use (adminitrative data from the

National Health Insurance Fund )

according to the country of origin distinguishing countries from North

Africa


To deepen the study of the role of access to health insurance

To evaluate the impact on health status and health care of specific public

insurance proposed to migrant population

Immigrants in France




1

Immigrants, foreigners, naturalized

8.3% of French population = 5.2 millions (2007)

1


More than one million immigrants at the beginning of 20th century (3% total

population)

Pro immigration policies (gov agencies and NGOs)

After WWI till 29 crisis

After WWII to 1973

6.6% in 1930

7.5% in 1975

8.3% in 2007

1


Before WWI: mostly neighbouring countries (Italy, Belgium...)

After WWI:

Along the 20’s : Spain, Italy, Eastern Europe (Poland +++)

Armenians, Russians following Russian revolution and Armenian genocide

After 1936: Spanish republicans

After WWII

Portugal, Maghreb, Sub-Saharian Africa, South-East Asia

European immigrants: 78.7% in 1962 44.9% in 1999

NA immigration starts around 1910

1


1

Workers, family members, refugees and students

1


1


15% of immigrants below poverty line

(20% among Maghreb immigrants)

Vs. 6% general population

IRDES & EUNAMHow we plan to participate




1

(WP1) Health, biological and psycho-social well being of NA migrants in EU

compared with natives and other immigrants groups

(Irdes = 5) Irdes describes the situation in France year 2

SAH : QES santé migrants + second generation, with a focus on NA (France)

Mental health ESPS, HSM 2008 (possibility for Iresp call) with focus on NA (France)

Social capital: migrants vs. aboriginals, with focus on NA, and second generation (done?)

Health behaviors: migrants vs. aboriginals, with focus on NA, and second generation

2 months research director + research fellow (12 months), Total 14 months

(WP3) Health care utilization by immigrants compared to natives

(IRDES= 20: coordination, describes the situation in France year 1EU-NA situation summarized in year

4)

WP Coordination

Access to Health care

- Discrimination

Evidence review

- Unmet needs

France, EU comparison if possible

- Health services utilization

Migrants vs. aboriginals, with focus on NA, and second generation, European comparison if possible

Ambulatory care, hospital care, preventive care

Access to health insurance

- Migrants vs. aboriginals, with focus on NA, and second generation (France, EU maybe)

- Evaluation of impact of specific migrants health insurance programs (France: AME)

Impact of migrants financial transfers on access to health care and insurance in the country of origin

(???)

10 months senior research fellow, 12 months research fellow, Total 22 months

1

(WP4) Population well being and health care in NA with time trends (IRDES=5 : French experience years 3 and 4)

France helps on methodology and econometric workframe if needed, from WP1 and WP3

Coordinator: XX

Team XX

2 months senior or junior research fellow

(WP6) Lessons for prevention in NA, EU and the world (EUNAM results synthesis?)

2 months ??

(WP7) Knowledge and skills n health studies related to immigrants are

advanced through training, information transfer and outlining of research

and policy targets

(IRDES= 5 training and policy recommendations)

5 months ??

IRDESInstitute for research and

documentation in health economics

Paul Dourgnon

Marie Lenormand

2

Who we are

IRDES created back in 1988

IRDES is a pluri-disciplinary structure in

-Economics

-Statistics

-Public Health

75 % funding come from main sickness funds

25% funding come from call for tenders

3

What we do

-Academic research and expertise

For research community

For institutions

-Data production

Data base « Eco-santé » (statistical series on health, health

expenditure, medical demography, medical activities)

General population surveys (ESPS, PSCE, EHIS, SHARE)

Microdata

Representative

Longitudinal

International

4

• Health Care System

Outpatient and inpatient care supply

Organisation, efficiency, quality, practice variations

• Health insurance

Compulsory and complementary insurance

Means tested complementary insurance

Health public expense prospective (microsimulation)

• Health and work

Health at work

Health and retirement

• Ageing and long-term care


5


• Equity and access to health care

Social health inequalities

Access to health services and insurance

Health and place

Equity in fundings and redistribution

EUNAM project at IRDES part of equity and access

to health care streams of research

• International comparisons

• Public policy evaluation

6

IRDES as part of international networks

• IRDES takes part in many European research

projects and networks

EHPG, Interlinks, Era-age, Euro-reach, Eunam…

• IRDES conducts European surveys

SHARE – Survey of Health Ageing and Retirement in

Europe (since 2002)

EHIS – European Health Interview Survey in 2014 and

onwards

7

If you want to know more about IRDES


We will be happy to welcome you in Paris for a

EUNAM meeting

Last but not least…


health status and health care use of migrants in france irdes · 2015-01-29 · health status and...

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