Inégalités de santé, inégalités de soins dans les territoires français

Vigneron, Emmanuel

doi:10.1016/s0001-4079(19)31781-9

Cited by 7 publications

(4 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The use of an ascending hierarchical classification is justified by this geographic aggregation. Clustering techniques and the geographic approach illustrate the interplay between the socioeconomic environment and healthcare issues which include access to health care in France [ 60 , 61 ]. The 6 clusters from the classification divide the territory according to the weight of each variable selected by the AHC.…”

Section: Discussionmentioning

confidence: 99%

Spatial distribution of in- and out-of-hospital mortality one year after acute myocardial infarction in France

Piccard

Roussot

Cottenet

et al. 2020

American Journal of Preventive Cardiology

View full text Add to dashboard Cite

Objective To describe the spatial distribution of acute myocardial infarction (AMI) mortality in France in association with the socio-economic characteristics of the patient’s place of residence. Methods In this population-based study, we included patients hospitalized for AMI identified according to ICD-10 codes, using data from the national health insurance database from January 1, 2013 to December 31, 2014. In- and out-of-hospital deaths were identified over a period of 1 year following the first hospital stay for AMI. An exploratory analysis was performed to classify area profiles. The spatial analysis of AMI mortality was performed using a principal component analysis followed by an ascending hierarchical classification taking into account socio-economic data, access-time by road to coronary angiography, standardized in-hospital prevalence, and 1 year mortality. Results Over the 2 years, 115,418 patients were hospitalized with a diagnosis of AMI. Patients were a mean of 68 ± 15 years and most were men (68.5%). The overall mortality rate was 12.2% after 1 year. More than half of patients (65.5%) underwent an early revascularization procedure. The map of standardized 1 year mortality showed a geographic area of high mortality extending diagonally from north-east to south-west France. We identified 6 different area profiles with standardized mortality varying from 15.9 to 54.4 per 100,000 inhabitants. The spatial distribution of higher mortality was associated with lower socioeconomic levels. These findings were not associated with a lower access to coronary angiography. Conclusion There are considerable geographical differences in the prevalence of AMI and 1 year mortality. The spatial distribution of lower healthcare indicators follows the distribution of social inequalities. This study highlights the importance of focusing national policies on universally accessible prevention programs such as the promotion cardiac rehabilitation and healthy lifestyles.

show abstract

Section: Discussionmentioning

confidence: 99%

Spatial distribution of in- and out-of-hospital mortality one year after acute myocardial infarction in France

Piccard

Roussot

Cottenet

et al. 2020

American Journal of Preventive Cardiology

View full text Add to dashboard Cite

show abstract

“…Criticism of the French health system exists despite its achievement of universal health coverage under a public-private health insurance system; critics identify prominent health disparities associated with the mixed public-private system model (Rodwin, 2003;Vigneron, 2012). For instance, the geographic distribution of health resources creates disparities in mortality outcomes across France.…”

Section: Criticisms Of Uhcmentioning

confidence: 99%

“…Under the SHI, where equality is the catchphrase of the entire healthcare system, experiencing health disparities is rather unfortunate. Access to care services reduces as the geographical distance extends from urban to remote areas (Vigneron, 2012). For instance, many public health policy solutions attend more to urban areas than in remote areas.…”

Section: Criticisms Of Uhcmentioning

confidence: 99%

“…The lack of coordination and case management services by these hospitals has increased the awareness of healthcare issues surrounding patients with chronic diseases and older patients. Critics suggest these issues are aggravated by the radical nature of the French health system (Rodwin, 2003;Vigneron, 2012;OECD, 2019), but it ranked first in the world in 2000. It still comes out well in rankings, although ranking depends on what is seen as most important (see Global Burden of Disease Study 2016) (Ryan et al, 2017).…”

Section: Criticisms Of Uhcmentioning

confidence: 99%

See 1 more Smart Citation

Obstacles and Challenges affecting the move towards Universal Healthcare Coverage in Nigeria

Jenson¹

View full text Add to dashboard Cite

There is increasing pressure for low and middle-income countries to move towards achieving universal healthcare coverage (UHC). According to WHO (2013), UHC guarantees the right to affordable health care for every individual, without financial hardship. The Director-General to the World Health Organization, Margaret Chan (WHO, 2010 p. 1), says UHC “is the single most powerful concept that public health has to offer”. In recent years, UHC has come onto the policy agenda, but Nigeria has been criticised for its slow progress. This study investigates why and how the UHC policy is developed by focusing on the roles and interactions of policy actors, their policy setting, and ‘how’ their actions influence the policy process and outcome of UHC so far in Nigeria. It will provide evidence of Nigeria’s policy process that will enhance the understanding of the politics of such health care policy implementation processes, which is fundamental to the success of policy networks of UHC in low- and middle-income settings. This is an empirical study using a mixed method approach involving quantitative and qualitative research components. The study combines the social network analysis (the quantitative component) with a more general policy process framework (the qualitative component). Data collected between March 2016 and February 2017 involved face-to-face structured interviews, face-to-face semi-structured interviews and documentary analysis to identify members of relevant policy networks and describe the pattern of relationships and influence within the UHC discourse. The SNA analysis displayed a full structural network taxonomy of the UHC policy process and identified key members of the UHC discourse into four key institutions and organisations- such as the power actors, peripheral actors, gatekeepers or brokers, isolated actors, and policy actors connected to the power actors. The theoretical policy process framework highlights five key gaps that exist as challenges and obstacles which impedes the implementation process of UHC Nigeria. These challenges and obstacles include, changing political climate, concerns about system capacity and finance, poor coordination between federal and state levels, corruption and problems with the private sector – HMOs. These challenges and obstacles limit the government’s ability to provide social and financial risk protection and access to quality health services to vulnerable Nigerian communities. Drawing on the theoretical framework and intervention, this thesis concludes that the political, policy, financial and organizational constraints of the health system limit UHC Nigeria implementation progress. Addressing the reasons why these issues ensue would be helpful in taking strategic steps towards achieving financial protection and access to basic health services through UHC for many Nigerians.

show abstract

The use of national administrative data to describe the spatial distribution of in-hospital mortality following stroke in France, 2008–2011

et al. 2016

View full text Add to dashboard Cite

Background: In the context of implementing the National Stroke Plan in France, a spatial approach was used to measure inequalities in this disease. Using the national PMSI-MCO databases, we analyzed the in-hospital prevalence of stroke and established a map of in-hospital mortality rates with regard to the socio-demographic structure of the country. Methods:The principal characteristics of patients identified according to ICD10 codes relative to stroke (in accordance with earlier validation work) were studied. A map of standardized mortality rates at the level of PMSI geographic codes was established. An exploratory analysis (principal component analysis followed by ascending hierarchical classification) using INSEE socio-economic data and mortality rates was also carried out to identify different area profiles.Results: Between 2008 and 2011, the number of stroke patients increased by 3.85 %, notably for ischemic stroke in the 36-55 years age group (60 % of men). Over the same period, in-hospital mortality fell, and the map of standardized rates illustrated the diagonal of high mortality extending from the north-east to the south-west of the country. The most severely affected areas were also those with the least favorable socio-professional indicators. Conclusions:The PMSI-MCO database is a major source of data on the health status of the population. It can be used for the area-by-area observation of the performance of certain healthcare indicators, such as in-hospital mortality, or to follow the implementation of the National Stroke Plan. Our study showed the interplay between social and demographic factors and stroke-related in-hospital mortality. The map derived from the results of the exploratory analysis illustrated a variety of areas where social difficulties, aging and high mortality seemed to meet. The study raises questions about access to neuro-vascular care in isolated areas and in those in demographic decline. Telemedicine appears to be the solution favored by decision makers. The aging of the population managed for stroke must not mask the growing incidence in younger people, which raises questions about the development of classical (smoking, hypertension) or new (drug abuse) risk factors.

show abstract

Inégalités de santé, inégalités de soins dans les territoires français

Cited by 7 publications

References 5 publications

Spatial distribution of in- and out-of-hospital mortality one year after acute myocardial infarction in France

Spatial distribution of in- and out-of-hospital mortality one year after acute myocardial infarction in France

Obstacles and Challenges affecting the move towards Universal Healthcare Coverage in Nigeria

The use of national administrative data to describe the spatial distribution of in-hospital mortality following stroke in France, 2008–2011

Contact Info

Product

Resources

About