Zeynep Or

IRDES Institut de recherche et documentation en économie de la santé | IRDES

Bismarckian health systems are mainly governed by social health insurers, but their role, status, and power vary across countries and over time. We compare the role of health insurers in three distinct social health insurance systems in improving health systems' efficiency. In France, insurers work together as a single payer within a highly regulat...

This review of the French health system analyses recent developments in health organisation and governance, financing, healthcare provision, recent reforms and health system performance. Overall health status continues to improve in France, although geographic and socioeconomic inequalities in life expectancy persist. The health system combines a s...

Background Most publicly-funded health systems purchase healthcare from private providers, but the optimal purchasing arrangements between public purchasers and private healthcare providers are yet to be determined. Objective This study compares the healthcare purchasing arrangements made with private providers in 2 social health insurance (SHI)-b...

This volume examines the public/private sector mix in a number of national healthcare systems and their interface with the goals of health equity and quality of healthcare. Moreover, there is a consideration of public accountability. The unique significance of this collection of national studies involving the public/private sector mix of healthcare...

This volume examines the public/private sector mix in a number of national healthcare systems and their interface with the goals of health equity and quality of healthcare. Moreover, there is a consideration of public accountability. The unique significance of this collection of national studies involving the public/private sector mix of healthcare...

One of the most pressing challenges facing most health care systems is rising costs. As the population ages and the demand for health care services grows, there is a growing need to understand the drivers of these costs across systems. This paper attempts to address this gap by examining utilization and spending of the course of a year for two spec...

Background Oral health, coupled with rising awareness on the impact that limited dental care coverage has on oral health and general health and well-being, has received increased attention over the past few years. The purpose of the study was to compare the statutory coverage and access to dental care for adult services in 11 European countries usi...

Objective: To establish a methodological approach to compare two high-need, high-cost (HNHC) patient personas internationally. Data sources: Linked individual-level administrative data from the inpatient and outpatient sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries: Austral...

Background: Oral health has received increased attention over the past few years coupled with rising awareness on the impact of limited dental care coverage for oral health and general health and well-being. The purpose of the study was to compare the statutory coverage and access to dental care for adult services in 11 European countries using a v...

Provider payment mechanisms were adjusted in many countries in response to the COVID-19 pandemic in 2020. Our objective was to review adjustments for hospitals and healthcare professionals across 20 countries. We developed an analytical framework distinguishing between payment adjustments compensating income loss and those covering extra costs rela...

This study focuses on financing for long-term care (LTC). LTC involves a range of services including medical and nursing care, personal care services, assistance services and social services that help people live independently or in residential settings when they can no longer carry out routine activities on their own. Governments should invest in...

Countries with social health insurance (SHI) systems display some common defining characteristics - pluralism of actors and strong medical associations - that, in dealing with crisis times, may allow for common learnings. This paper analyses health system responses during the COVID-19 pandemic in eight countries representative of SHI systems in Eur...

Objective: To compare within-country variation of health care utilization and spending of patients with chronic heart failure (CHF) and diabetes across countries. Data sources: Patient-level linked data sources compiled by the International Collaborative on Costs, Outcomes, and Needs in Care across nine countries: Australia, Canada, England, Fra...

Objective The objective of this study was to explore cross-country differences in spending and utilization across different domains of care for a multimorbid persona with heart failure and diabetes. Data Sources We used individual-level administrative claims or registry data from inpatient and outpatient health care sectors compiled by the Interna...

Objective The objectives of this study are to compare the relative use of different post-acute care settings in different countries and to compare three important outcomes: total expenditure; total days of care in different care settings; and overall longevity over a one-year period following a hip fracture. Data Sources We used administrative dat...

Objective: This study explores variations in outcomes of care for two types of patient personas-an older frail person recovering from a hip fracture and a multimorbid older patient with congestive heart failure (CHF) and diabetes. Data sources: We used individual-level patient data from 11 health systems. Study design: We compared inpatient mo...

Objective This study explores differences in spending and utilization of health care services for an older person with frailty before and after a hip fracture. Data Sources We used individual-level patient data from five care settings. Study Design We compared utilization and spending of an older person aged older than 65 years for 365 days befor...

The challenges faced by health systems worldwide have been rising over time with the rapid increase in costly new medical treatments and the mounting prevalence of non-communicable diseases in an ageing population. The French healthcare system is not spared by these pressures. In addition, the COVID-19 pandemic has been testing its resilience to cr...

France is one of the European countries hardest hit by the Covid-19 pandemic. The pandemic brought into light structural weaknesses of the health system, including its governance and decision-making process, but also provoked changes that helped to improve its resilience. We analyse the French experience of Covid-19 in 2020 by critically reviewing...

France is one of the European countries hardest hit by the Covid-19 pan-demic. The pandemic brought into light structural weaknesses of the health system, including its governance and decision making process, but also provoked changes that helped to improve its resilience. We analyse the French experience of Covid-19 in 2020 by critically reviewing...

During the COVID-19 pandemic, hospitals face the concurrent challenges of maintaining routine services while attending to COVID-19 patients. This article shares approaches taken in six countries to resume hospital care after the first wave of the pandemic by surveying country experts and using data extracted from the COVID-19 Health Systems Respons...

Background: The implications of competition among hospitals on care quality have been the subject of considerable debate. On one hand, economic theory suggests that when prices are regulated, quality will be increased in competitive markets. On the other hand, hospital mergers have been justified by the need to exploit cost advantages, and by evid...

Background As part of the EU funded BRIDGE Health project, 23 headline indicators for assessing and comparing the performance of public health systems were proposed. They were shortlisted out of the currently existing and often overlapping pool of over 2000 health system performance assessment (HSPA) indicators. In this qualitative study, we explor...

Background: The availability of data generated from different sources is increasing with the possibility to link these data sources with each other. However, linked administrative data can be complex to use and may require advanced expertise and skills in statistical analysis. The main objectives of this study were to describe the current use of d...

Introduction: Long-term care (LTC) is organized in a fragmented manner. Payer agencies (PA) receive LTC funds from the agency collecting funds, and commission services. Yet, distributional equity (DE) across PAs, a precondition to geographical equity of access to LTC, has received limited attention. We conceptualize that LTC systems promote DE when...

This graph shows the number of hospitalizations for Covid-19 in different European countries, for the same share of population identified as Covid-19 (number of confirmed cases between 141-146 per 100,000 inhabitants). The number of people hospitalized for Covid-19 varies from about 10 people per 100,000 inhabitants in Austria and Portugal (includ...

Introduction Long-term care (LTC) is organized in a fragmented manner. Payer agencies (PA) receive LTC funds from the agency collecting funds, and commission services. Yet, distributional equity (DE) across PAs, a precondition to geographical equity of access to LTC, has received limited attention. We conceptualize that LTC systems promote DE when...

Background The availability of data generated from different sources is increasing with the possibility to link these data sources together. However, linked administrative data can be complex to use and may require advanced expertise and skills in statistical analysis. The main objectives of this study were to describe the current use of data linka...

Background: The availability of data generated from different sources is increasing with the possibility to link these data sources with each other. However, linked administrative data can be complex to use and may require advanced expertise and skills in statistical analysis. The main objectives of this study were to describe the current use of da...

All countries in Europe will have to find solutions to protect hospitals from revenue shortfalls and to adequately reimburse for COVID-19-related costs of care. This article reports on changes to hospital payment systems in Belgium, the United Kingdom (England). Hospitals in these countries are paid for treating COVID-19 patients using the usual sy...

In France, publicly funded mental care services are mostly hospital-based and focused on treating severe illnesses. Mild to moderate mental disorders are typically managed by general practitioners (GP) who often lack specific training to treat these conditions. Antidepressant prescribing levels for mild to moderate conditions are inadequately high....

Assurer une prise en charge sanitaire et sociale adaptée aux besoins des personnes âgées est un enjeu majeur des politiques publiques. Dans le cadre des expéri-mentations Parcours santé des aînés (Paerpa), lancées en 2014 pour améliorer la prise en charge des personnes âgées en « risque de perte d’autonomie », un outil de coordination, le Plan pers...

Reducing repeated hospitalizations of patients with chronic conditions is a policy objective for improving system efficiency. We test the hypothesis that the risk of readmission is associated with the timing and intensity of primary care follow-up after discharge, focusing on patients hospitalized for heart failure in France. We propose a discrete-...

Introduction La coordination des soins avant et après une hospitalisation est importante pour améliorer la qualité de prise en charge des patients et l’efficience du système de santé. Différents protocoles de soins centrés sur le patient ont été développés dans la littérature médicale. Ils sont de plus en plus employés dans les établissements de sa...

Coordination of care provided before and after a hospitalization is essential for improving the quality of patient care and efficiency of health system. Various patient-centered care protocols have been developed in the medical literature for improving patient care pathways. They are increasingly promoted and employed in healthcare facilities. In t...

Les expérimentations Parcours santé des aînés (Paerpa), lancées en 2014 dans neuf territoires pilotes, ont pour objectif d’améliorer la prise en charge et la qualité de vie des personnes âgées de 75 ans et plus et de leurs aidants en faisant progresser la coordination des différents intervenants des secteurs sanitaire, social et médico-social au ni...

Regional pilots, healthcare pathways of seniors (Paerpa) launched in 2014 in nine territories (local areas) with the objective of improving care coordination and quality of life for frail elderly people (75 +) are an example of complex social experiment. They combine a series of national schemes implemented heterogeneously from one territory to ano...

Background: Rising numbers of visits to emergency departments (EDs), especially amongst the elderly, is a source of pressure on hospitals and on the healthcare system. This study aims to establish the determinants of ED visits in France at a territorial level with a focus on the impact of ambulatory care organisation on ED visits by older adults a...

Better monitoring of patients in primary care setting is often considered to be a solution for reducing avoidable hospitalisations and readmissions. In this paper we test the hypothesis that the risk of readmission is associated with the timing and intensity of primary care follow-up, with a focus on consultations with a generalist (GP) after disch...

This is the final version of the article. It first appeared from the National Institute for Helath Research via http://dx.doi.org/10.3310/hsdr04160

Adverse events bring into question the safety and quality of care for patients, but also represent a significant cost for society. For example, the annual cost of nine adverse events assessed in a study by the French Institute for Research and Documentation in Health Economics (IRDES) was estimated at €682 million in 2007. Copyright © 2016 Elsevier...

This chapter provides an overview of the practice variations in care delivery for mental health and addictive disorders and some of the system-level funding and structural factors that contribute to such variation. Practice variations are described for five populations, along with their expected clinical picture and service needs: Children and adol...

Aims Minimum volume thresholds were introduced in France in 2008 to improve the quality of cancer care. We investigated whether/how the quality of treatment decisions in breast cancer surgery had evolved before and after this policy was implemented. Methods We used Hospital Episode Statistics for all women having undergone breast conserving surger...

This chapter provides an overview of the practice variations in care delivery for mental health and addictive disorders and some of the system-level funding and structural factors that contribute to such variation. Practice variations are described for five populations, along with their expected clinical picture and service needs: Children and adol...

Lancées en 2014 dans neuf territoires pilotes, les expérimentations « Parcours santé des aînés » (Paerpa) ont pour objectif d’améliorer la prise en charge et la qualité de vie des personnes âgées de 75 ans ou plus et de leurs aidants. Les projets visent à faire progresser la coordination des différents intervenants des secteurs sanitaire, social et...

Lancées en 2014 dans neuf territoires pilotes, les expérimentations « Parcours santé des aînés » (Paerpa) ont pour objectif d’améliorer la prise en charge et la qualité de vie des personnes âgées de 75 ans ou plus et de leurs aidants. Les projets visent à faire progresser la coordination des différents intervenants des secteurs sanitaire, social et...

Variations in health care use within a country are complicated. In some cases they may reflect differences in health needs, in patient preferences or in the diffusion of a therapeutic innovation; in others they may not. There is evidence that some of the observed variations are unwarranted, signalling under- or over-provision of health services, or...

In France, a DRG-based payment system was introduced in 2004/2005 for funding acute services in all hospitals with the objectives of improving hospital efficiency, transparency and fairness in payments to public and private hospitals. Despite the initial consensus on the necessity of the reform, providers have become increasingly critical of the sy...

While Universal Health Coverage (UHC) offers a powerful goal for a nation, all countries-irrespective of income- are struggling with achieving or sustaining UHC. France is a high-income country where health coverage is in effect universal. Health-related costs are covered by a mix of mandatory Social Health Insurance (SHI) and private complementary...

Résumé : Cet article analyse les variations territoriales de pratiques de prostatectomies en France. Nous recourons à une modélisation multiniveaux permettant de distinguer la variabilité liée à deux niveaux géographiques : le département et la région. Nos résultats montrent que les taux de prostatectomies standardisés (pour 100 000 hommes) varient...

Diagnosis related groups (DRGs) were originally developed in the 1970s by researchers at Yale University. Their aim was to define “hospital products” and to measure what hospitals actually do. Medicare in the United States soon realised the potential of DRGs for paying hospitals for their work and introduced the first DRG based payment system in 19...

The activity-based funding (T2A) is used since 2004-2005, for financing acute hospital care in public and private hospitals with an objective to improve the efficiency of individual providers and the hospital sector as a whole. To date, however, the impact of T2A on hospital activity, productivity and quality of care has only been partially evaluat...

Appendectomy is a common and relatively simple procedure to remove an inflamed appendix, but the rate of appendectomy varies widely across Europe. This paper investigates factors that explain differences in resource use for appendectomy. We analysed 106 929 appendectomy patients treated in 939 hospitals in 10 European countries. In stage 1, we test...

Childbirth is one of the main causes of hospitalisation for women, accounting for about 5% of hospital activity in most Organisation for Economic Co-operation and Development countries. We analysed the factors that explain variations in resource use for child delivery in ten European countries. We compared the performance of three models for explai...

Appendectomy is a common and relatively simple procedure to remove an inflamed appendix, but the rate of appendectomy varies widely across Europe. This paper investigates factors that explain differences in resource use for appendectomy. We analysed 106,929 appendectomy patients treated in 939 hospitals in ten European countries. In stage one, we t...

Patient safety practices, targeting organisational changes for improving patient safety, are implemented worldwide but their costs are rarely evaluated. This paper provides a review of the methods used in economic evaluation of such practices. International medical and economics databases were searched for peer-reviewed publications on economic eva...

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 servic...

[This corrects the article DOI: 10.1007/s10433-011-0201-9.].

Following the US experience, activity-based funding has become the most common mechanism for reimbursing hospitals in Europe. Focusing on five European countries (England, Finland, France, Germany and Ireland), this paper reviews the motivation for introducing activity-based funding, together with the empirical evidence available to assess the impa...

A standard doctor visit or routine check-up can be essential for maintaining good health. People who have regular checkups may identify health issues well before any symptoms show up and receive the treatment for reducing onset and complications. Many of the costly and disabling conditions can be prevented through early detection. Therefore, improv...

Industrialised countries face similar challenges for improving the performance of their health system. Nevertheless, the nature and intensity of the reforms required are largely determined by each country’s basic social security model. Most reforms in Beveridge-type systems have sought to increase choice and reduce waiting times while those in majo...

This study contributes to the literature on the link between hospital volume and outcomes of care by exploiting for the first time the French hospital data at a national level. Using multilevel models, we test the strength and the shape of the relationship for eight conditions. The results suggest that activity volumes may be a good measure of regu...

Rational: In Europe it is well documented that significant inequalities exist in the use of health-care services across socio-economic groups. There is also evidence that the degree of this inequality in access to care varies significantly from one country to other. Nevertheless, in previous work little attention is paid to the role of the health-c...

This study examines the impact of health system characteristics on social inequi-ties 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 spe...