Disparities in access to health care in three French regions

Michael K. Gusmano, Daniel Weisz, Victor G. Rodwin, Jonas Lang, Meng Qian, Aurelie Bocquier, Veronique Moysan, Pierre Verger

Research output: Contribution to journalArticle

Abstract

Objectives: This paper compares access to primary and specialty care in three metropolitan regions of France: Ile de France (IDF), Nord-Pas-de-Calais (NPC) and Provence-Alpes-CÔte d'Azur (PACA); and identifies the factors that contribute to disparities in access to care within and among these regions. Methods: To assess access to primary care, we compare variation among residence-based, age-adjusted hospital discharge rates for ambulatory care sensitive conditions (ASC). To assess access on one dimension of specialty care, we compare residence-based, age-adjusted hospital discharge rates for revascularization - bypass surgery and angioplasty - among patients diagnosed with ischemic heart disease (IHD). In addition, for each region we rely on a multilevel generalized linear mixed effect model to identify a range of individual and area-level factors that affect the discharge rates for ASC and revascularization. Results: In comparison with other large metropolitan regions, in France, access to primary care is greater in Paris and its surrounding region (IDF) than in NPC but worse than in PACA. With regard to revascularization, after controlling for the burden of IHD, use of services is highest in PACA followed by IDF and NPC. In all three regions, disparities in access are much greater for revascularization than for ASC. Residents of low-income areas and those who are treated in public hospitals have poorer access to primary care and revascularizations. In addition, the odds of hospitalization for ASC and revascularization are higher for men. Finally, people who are treated in public hospitals, have poorer access to primary care and revascularization services than those who are admitted for ASC and revascularization services in private hospitals. Conclusions: Within each region, we find significant income disparities among geographic areas in access to primary care as well as revascularization. Even within a national health insurance system that minimizes the financial barriers to health care and has one of the highest rates of spending on health care in Europe, the challenge of minimizing these disparities remains.

Original languageEnglish (US)
Pages (from-to)31-40
Number of pages10
JournalHealth Policy
Volume114
Issue number1
DOIs
StatePublished - Jan 2014

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Health Services Accessibility
Ambulatory Care
Primary Health Care
France
Public Hospitals
Myocardial Ischemia
Delivery of Health Care
Private Hospitals
National Health Programs
Paris
Angioplasty
Hospitalization

Keywords

  • Access to care
  • Equity
  • France

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Gusmano, M. K., Weisz, D., Rodwin, V. G., Lang, J., Qian, M., Bocquier, A., ... Verger, P. (2014). Disparities in access to health care in three French regions. Health Policy, 114(1), 31-40. https://doi.org/10.1016/j.healthpol.2013.07.011

Disparities in access to health care in three French regions. / Gusmano, Michael K.; Weisz, Daniel; Rodwin, Victor G.; Lang, Jonas; Qian, Meng; Bocquier, Aurelie; Moysan, Veronique; Verger, Pierre.

In: Health Policy, Vol. 114, No. 1, 01.2014, p. 31-40.

Research output: Contribution to journalArticle

Gusmano, MK, Weisz, D, Rodwin, VG, Lang, J, Qian, M, Bocquier, A, Moysan, V & Verger, P 2014, 'Disparities in access to health care in three French regions', Health Policy, vol. 114, no. 1, pp. 31-40. https://doi.org/10.1016/j.healthpol.2013.07.011
Gusmano, Michael K. ; Weisz, Daniel ; Rodwin, Victor G. ; Lang, Jonas ; Qian, Meng ; Bocquier, Aurelie ; Moysan, Veronique ; Verger, Pierre. / Disparities in access to health care in three French regions. In: Health Policy. 2014 ; Vol. 114, No. 1. pp. 31-40.
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