Just a question of time? Explaining non-take-up of a public health insurance program designed for undocumented immigrants living in France.

State Medical Aid is a public health insurance program that allows undocumented immigrants with low financial resources to access health care services for free. However, the low take-up rate of this program might threaten its efficiency. The purpose of this study is therefore to provide the determinants of such a low take-up rate. To this end, we rely on the Premier Pas survey. This is an original representative sample of undocumented immigrants attending places of assistance to vulnerable populations in France. Determinants of State Medical Aid take-up are analyzed through probit and Cox modeling. The results show that only 51% of those who are eligible for the State Medical Aid program are actually covered, and this proportion is higher among women than among men. The length of stay in France is the most important determinant of take-up. It is worth noting that State Medical Aid take-up is not associated with chronic diseases or functional limitations and is negatively associated with poor mental health. There is, therefore, mixed evidence of health selection into the program. Informational barriers and vulnerabilities experienced by undocumented immigrants are likely to explain this low take-up.

[Inequalities in access to care and their evolution: a review]. / Les inégalités de recours aux soins: bilan et évolution.

Tackling health inequalities is one of the main public health goals, and equity of access to care is a necessary condition to achieve this objective. Analyzing and assessing inequalities in health care use is therefore essential in order to enlighten public health policies. This article proposes a review on inequalities in access to care in France and OECD countries, their causes and their evolution. During the last decades, inequalities in health care expenditure have decreased in France with diffusion of complementary insurance, due in particular to the CMU-C implementation in 2000, but they are still significant. The reduction of inequalities is particularly important for GP use, for which we observe now pro-poor inequities. However, there are persistent and important inequalities in access to specialist care, as well as in preventive care. Therefore, France is still one of the European countries with the highest level of inequities in access to care.

Job loss from poor health, smoking and obesity: a national prospective survey in France.

BACKGROUND AND OBJECTIVES: Health selection into unemployment may be either direct or operate by reference to health-related behaviours rather than health per se (indirect selection). Panel data are desirable to investigate selection effects, and the two types of selection processes may be concurrent. We examine jointly the roles of health and health-related behaviours as precursors of unemployment, in order to disentangle direct from indirect selection processes. DESIGN: The data of a multi-round nationally representative health survey in France were analysed longitudinally, based on three data collection rounds: 1992-5, 1996-8 and 2000-2. Following employees salaried in the private sector and aged 30-54 years at baseline, we explored through logistic regression the influence of non-optimal self-rated health, smoking and obesity on the risk of being found unemployed 4 years later. RESULTS: After adjustment for self-rated health, obesity was found to be a significant precursor of unemployment in women, and heavy smoking had that role in men. After adjustment for smoking and obesity, poor health at baseline was found to be a significant precursor of unemployment in both genders. CONCLUSION: Those findings confirm the intrinsic role of poor health and of health-related behaviours as precursors of unemployment, with gender-specific patterns for the latter. Public policy prescriptions regarding employees' protection from job insecurities should integrate appropriate accommodations of health limitations, and the personal factors underlying unfavourable work and health behaviours should be investigated, in order to thwart indirect selection phenomena.

Healthy working life expectancies at age 50 in Europe: a new indicator.

OBJECTIVES: The absence of disease or disability and active involvement in society are considered as essential dimensions of successful ageing. To assess these concepts, we propose a new indicator the Healthy Working Life Expectancy (HWLE) that associates health status and productive engagement, in order to compare various situations in Europe. DESIGN: The study population is drawn from the European Community Household Panel (ECHP) which is the unique source of longitudinal data, providing comparable information between 1995 and 2001 on health and work statuses for a sample of some 60,000 household's representative of the population of: Austria, Belgium, Denmark, Finland, France, Germany, the United Kingdom, Greece, Italy, the Netherlands, Portugal, and Spain. Based on the multi-state life table approach conventionally used for calculating healthy life expectancies, the HWLE corresponds to the number of years spent between the ages of 50 and 70 both in good health and at work. RESULTS: In average, among the 20 years available between age 50 and age 70, the HWLE is 7.5 years for men and 4.8 years for women, ie, one half and one third respectively of the number of years spent in good health (14.1 and 13.5 years). The countries where the healthy working life expectancy of seniors is the highest are also the countries where the levels of employment of seniors are higher. Conversely, health status has only a weak influence on the HWLE indicator. CONCLUSION: These findings suggest the existence of a reservoir of healthy years which can be used to increase the length of the working life expectancy. They underline also the essential role that employment maintenance and retirement policies should have to increase the number of healthy years spent at work, and therefore guarantee a successful ageing for the seniors in Europe.