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Cette etude analyse la consommation de soins des travailleurs independants en les comparant aux employes, a differents âges, en France. Elle se base sur les donnees en coupe de l’Enquete sante et protection sociale (ESPS) appariees avec les donnees du systeme national d’assurance maladie. Nous decomposons la demande de soins de sante (ambulatoires et hospitaliers) selon l’âge et le sexe, a l’aide d’un modele en deux etapes. Les resultats montrent que, toutes choses egales par ailleurs, les independants (et surtout les hommes) tendent a consommer moins de soins ambulatoires durant les premieres phases de leur vie active, car leur emploi est plus exigeant (effet « must-trade »), mais que leur consommation augmente progressivement avec l’âge, rejoignant les niveaux des salaries apres leur depart en retraite (effet « catch-up »). Ces resultats, en accord avec la theorie economique, suggerent que la sante des independants decline plus rapidement au cours de leur vie. Du point de vue des politiques publiques, ils mettent en question, pour des raisons de sante publique, la strategie Europe 2020, qui recommande de developper le travail independant en Europe.

International audience; This paper explains the observed hospital congestion by physicians' decision to unconditionally refer patients to hospitals, and explain why such a choice is rational when congestion deteriorates the efficiency of the tirage process at the hospital level. In an imperfect information environment, physicians might refer to top-tier hospitals patients with mild diseases that could be properly addressed by regular hospitals, just to fulfill patients' demand for the best care. Yet, the tirage capability of top-tier hospitals declines if the hospital is subject to congestion, which, in turn, provides incentives to physicians to refer more patients to these hospitals. The model presents two equilibria, one with perfect triage, and another with triage errors and hospital congestion. In this last equilibrium, a higher hospital size raises the likelihood of congestion. Public policies strategies to overcome this issue are discussed. © 2021 Editions Dalloz Sirey. All rights reserved.

International audience; This systematic literature review documents the link between frailty or sarcopenia, conceptualized as dimensions of physical health, and the use of long-term care services by older individuals. Long-term care services include formal and informal care provided at home as well as in institutions. A systematic review was performed according to PRISMA requirements using the following databases: PubMed-Medline, Embase, CINAHL, Web of Science, and Academic Search Premier. We included all quantitative studies published in English between January 2000 and December 2018 focusing on individuals aged 50 or more, using a relevant measurement of sarcopenia or physical frailty and a long-term care related outcome. A quality assessment was carried out using the questionnaire established by the Good Practice Task Force Report of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Five subsets of long-term care outcome were considered: 1/ nursing home placement (NHP), 2/ nursing home short stay (NHSS), 3/ formal personal care (FPC), 4/ formal home help (FHH), 5/ informal care (IC). Out of 1943 studies, 17 were finally included in the review. With some studies covering several LTC outcomes, frailty and / or sarcopenia were associated with increased LTC use in 17 out of 26 cases (NHP: 5/6, NHSS: 3/4, FPC: 5/7, FHH: 1/4, IC: 3/5) The association was not consistent in 5 cases (NHP: 1/6, NHSS: 1/4, FPC: 2/7, FHH: 0/4, IC: 1/5) and the association was either not significant or the results inconclusive in the remaining 9 cases. Overall, while results on sarcopenia are scarce, evidence support a positive association between frailty and LTC use. The evidence is stronger for the association of physical frailty with nursing home placement / short stay as well as on FPC. There is less (more heterogeneous) evidence regarding the correlation between physical frailty and FHH or IC use. Results need to be confirmed by more advanced statistical methods or design based on longitudinal data.

International audience; Older adults regularly report rising levels of Subjective Well-Being (SWB) over time, despite a concomitant decline in their health. One possible explanation is that individuals develop psychological mechanisms to diminish the contribution of health to their well-being as they get older. This research examines whether observational data are consistent with this hypothesis of hedonic adaptation to health decline with ageing, in all aspects of SWB, and for different births cohorts over time. Using longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE) between 2007 and 2015 in 10 European countries for respondents aged 50 onwards (4 waves, 41,258 individuals), we estimated panel fixed-effects models for outcomes measuring the three aspects of SWB: evaluative (life satisfaction), experienced (positive and negative affectivity) and eudemonic well-being (sense of purpose and meaning in life). We decomposed age in birth cohort and time fixed effects. Changes over time in the contribution of health to SWB were estimated by interaction terms between health and time fixed effects. Results showed that the value of health changes over time and for different birth cohorts in ways that depend on the measure of SWB. Ageing increases the importance of health for both eudemonic and experienced well-being. By contrast, the association between health and life satisfaction weakens with age, except for individuals aged 80 and above for which it strengthens. Our results thus offer only little support for hedonic adaptation to health decline with age, restricted to life satisfaction and individuals under 80 years of age. These findings caution against the use of mean estimations over the lifespan to determine the value of health as well as against the use of the various forms of SWB interchangeably in public policy analysis and economic evaluations of healthcare.

International audience; Only few studies outside of the US have addressed the issue of out-of-pocket payments (OOP) at the end of life because of a lack of data. We use an exclusive dataset from a major French health insurance company (MGEN), including claim data, both mandatory and voluntary health insurance details, income and individual characteristics, for individuals aged 65 or older who died in 2017. We address three main issues: (1) What is the magnitude of OOP in France at the end of life? (2) How are OOP distributed, and do they present a financial risk to patients? (3) What are the determinants of OOP and what health system reforms could reduce them? Our results indicate that OOP expenses increase in the last year of life and accelerate in the last trimester. Despite some outliers, the French system is successful in protecting individuals from catastrophic OOP. Using generalised linear models, we confirm that improving the pathways of care could generate savings and partially reduce households’ financial burden. However, OOP are elastic to income and driven essentially by personal convenience demands. Using concentration curves and Gini coefficients, we show that providing additional insurance against end-of-life OOP would likely be regressive, i.e., socially non-desirable.

This study analyses the relationship between medication use and frailty by considering the quantity of medications prescribed (polypharmacy) and the quality of medication prescribing (according to French criteria for Potentially Inappropriate Medications—PIMs) in people aged 65 and over. This is a cross-sectional study based on the data from a nationally representative study about health and use of healthcare resources in France (ESPS 2012). The number of frailty criteria was assessed among exhaustion, unintentional weight loss, muscle weakness, impaired mobility, and low level of physical activity. Polypharmacy and PIMs were assessed from the data of reimbursement by the National Health Insurance over the whole year 2012. PIMs were defined according to the Laroche list plus additional criteria dealing with inappropriate prolonged use of medications. The analyses used Poisson regression models, with the number of frailty criteria as dependent variable. The study population was composed of 1003 women and 887 men, of mean age 74.7 +/− 7.4 years. Polypharmacy (5 to 9 drugs) and excessive polypharmacy (≥10 drugs) were reported in 42.9 and 27.4% of the study population, respectively, while 46.7% of the study population received at least one PIM during the year 2012. Polypharmacy and PIMs were both associated with the number of frailty criteria in models adjusted for socio-demographic and health characteristics of the participants. The prescription of anticholinergic medications was the only PIM that remained significantly associated with the number of frailty criteria after adjustment for polypharmacy. Polypharmacy and use of anticholinergic medications are independently associated with frailty in old people.

PurposeThe purpose of this paper is to estimate a reduced form model of expectations-based reference-dependent preferences to explain job retention of older workers in Europe in the context of the 2009 economic crisis.Design/methodology/approachUsing individual micro-economic longitudinal data from the Survey of Health, Ageing, and Retirement in Europe between 2006 and 2011, the authors derive a measure of “good, bad or no surprise” from workers’ anticipated evolution of their standard of living five years from 2006 (reference point) and from a comparison of their capacity to make ends meet between 2006 and 2011.FindingsThe authors find that the probability to remain on the labour market in 2011 is significantly higher for individuals who experienced a lower than expected standard of living. The effect of a “bad surprise” on job retention is larger than the effect of a “good surprise” once netted out from the effects of expectations at baseline, change in consumption utility, and the usual life-cycle determinants on job retention of older workers.Originality/valueThe authors interpret this result as an evidence of loss aversion in the case the reference point is based on individuals’ expectations. The authors also find that loss aversion is more common among men, risk-averse individuals and those with a higher perceived life expectancy.

International audience; The aim of this study was to document the extent to which diabetic patients who adhered to required medical follow‐ups in France experienced reduced hospital admissions over time. The main assumption was that enhanced monitoring and follow‐up of diabetic patients in the primary care setting could be a substitute for hospital use. Using longitudinal claim data of diabetic patients between 2010 and 2015 from MGEN, a leading mutuelle insurance company in France, we estimated a dynamic logit model with lagged measures of the quality of adherence to eight medical follow‐up recommendations. This model allowed us to disentangle follow‐up care in hospitals from other forms of inpatient care that could occur simultaneously. We found that a higher adherence to medical guidance is associated with a lower probability of hospitalization and that the take‐up of each of the eight recommendations may help reduce the rates of hospital admission. The reasons for the variation in patient adherence and implications for health policy are discussed.

Background The frailty phenotype for older people is defined as an increased vulnerability to stressors, leading to adverse health outcomes. It is acknowledged as a specific precursor of disability besides chronic diseases that allows for some reversibility in the loss of autonomy. Although the literature on the socio-economic determinants of frailty is emerging in cross-sectional settings, little is known about the dynamics of this relationship over time. This article examines the joint evolution of frailty and change in economic conditions for the 65+ in Europe. Methods Individual and longitudinal data from SHARE (Survey on Health, Ageing and Retirement in Europe) over the period 2004–12 has been used. The sample contains 31 044 observations from 12 002 respondents aged 65 or more. A fixed effect Poisson model is estimated in order to control for unobserved individual heterogeneity. Three types of explanative economic variables have been considered in turn: income, wealth and a subjective variable of deprivation. Results Our results indicate that individuals with worsening economic conditions (wealth and subjective deprivation) over time simultaneously experience a rapid increase in the frailty symptoms. Results also show that the nature of economic variable does not affect the frailty process in the same way. Subjective measure of deprivation seems to better evaluate the household’s financial difficulties than objective measure. Conclusion From a public policy perspective, these results show that policies fostering economic conditions of the elderly could have a significant impact on frailty and henceforth, could reduce the risks of disability.

International audience; Objectives: This study examines prescribers’ compliance with the 2011 clinical recommendation of the French National Authority for Health (HAS) aiming to limit the use of drugs specific to Alzheimer’s Disease (AD), and whether prescribers’ compliance differs as a function of patient gender.Study design: The sample consisted of quarterly data from the National Health Insurance claims database from 2010 to 2013 (16 quarters) for individuals living in the community, aged 65 or over at baseline.Methods: The probability of consuming AD drugs was estimated using a fixed effects model to account for individual and unobserved heterogeneity. Time-varying covariates were included to control for changes in health status and insurance effects. Estimations were carried out for men and women separately.Results: Discrepancies in trend of the probability of consuming AD drugs between women and men after the HAS’ 2011 recommendation were observed: the probability decreased for women while it remained constant for men.Conclusions: Our case study complements the literature on the influence of clinical recommendations by HTA body on clinical practices. Public health policies should take into account sex and gender differences in the management of AD patients. Further research should investigate how to implement gender targeted therapies and prevention, and their effects.; Objectif : Cette étude examine si les prescripteurs ont respecté la recommandation de la Haute Autorité de Santé de 2011 concernant la limitation des prescriptions de médicaments spécifiques à la maladie d’Alzheimer (MA) et si le respect de cette recommandation dépend du genre du patient.Design de l’étude : L’échantillon est composé de données trimestrielles de l’EGB de 2010 à 2013 (16 trimestres) pour des individus vivant à domicile et âgés de 65 ans et plus en 2010.Méthodes : La probabilité de consommer des médicaments spécifiques à la MA est estimée à partir d’un modèle de panel à effets fixes permettant de capturer l’hétérogénéité individuelle invariante dans le temps. Les variables explicatives variant dans le temps ont été incluses dans le modèle pour contrôler des variations d’état de santé et de remboursement. Les estimations ont été réalisées séparément pour les hommes et les femmes.Résultats : Une différence de tendance dans la probabilité de consommer des médicaments spécifiques à la MA entre les patients hommes et femmes est observée après la diffusion de la recommandation de la HAS en 2011 : cette probabilité décroit chez les femmes alors qu’elle reste stable chez les hommes.Conclusions : Notre cas d’étude complète la littérature sur l’influence des agences d’évaluation des technologies de santé sur les pratiques médicales. Les politiques de santé publique pour la prise en charge des patients atteints de la MA devraient prendre en compte les différences de genre des patients. De futures recherches devrait étudier comment mettre en place des thérapies et des politiques de prévention prenant en compte les différences de genre entre patients et leurs effets.

International audience; Health Authorities in France recently produced and made publicly available a wide array of regularly updated hospital care quality measures (www.scopesante.fr). Economic theory applied to healthcare markets predicts that monitoring costs incurred by Health Authorities (the principal) to signal hospitals’ (the agent) quality should create incentives for the latter to improve their Quality and Safety Indicators (QSIs). However, patients rarely refer to technical quality information to choose between hospitals. They are more prone to make use of subjective appraisals (such as word-of-mouth) of which patients’ satisfaction is a proxy. Using a unique dataset of 2,323 hospitals in France, and overcoming sample selection issues, we found a strong and positive correlation between a standardized measure of patients’ satisfaction (e-satis) and various measures of QSIs. Our results suggest that, since patients use a signal that carries information about quality, hospitals could be incited to increase healthcare quality.; Les autorités sanitaires françaises ont récemment produit et mis à disposition du public un large éventail de mesures de la qualité des soins hospitaliers, régulièrement mises à jour (www.scopesante.fr). La théorie économique appliquée aux marchés des soins de santé prédit que les coûts de surveillance engagés par les autorités de santé au bénéfice du patient (le principal) pour signaler la qualité des hôpitaux (les agents) devraient inciter ces derniers à améliorer les indicateurs de qualité et de sécurité des soins (IQSS). Cependant, les patients se réfèrent rarement à l’information clinique, technique de qualité des soins afin de discriminer les hôpitaux; et sont davantage enclins à utiliser des évaluations subjectives (telles que le bouche-à-oreille) dont la satisfaction des patients peut être un indicateur indirect. A l’aide d’un échantillon unique de données concernant 2 323 hôpitaux en France métropolitaine et en surmontant les problèmes de sélection inhérents à notre échantillon, nous trouvons une forte corrélation entre une mesure standardisée de la satisfaction des patients, e-satis, et diverses mesures des IQSS. Nos résultats suggèrent que, puisque les patients utilisent un signal qui transmet des informations sur la qualité, les hôpitaux pourraient être incités à améliorer la qualité des soins.

In a global context of population aging, gaining better knowledge of the mechanisms leading to loss of autonomy has become a major objective, notably with the aim of implementing effective preventive health policies. The concept of frailty, originally introduced in gerontology and geriatrics as a precursor state to functional dependency, appears as a useful tool in this specific context. The "Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies" (SPRINTT) project will provide a unique opportunity to explore health economics issues associated with frailty. In terms of health economics, the loss of autonomy approach retained here focuses on the economic and social causes and consequences of the onset of frailty in older adults, and examines the challenges not only in terms of health system efficiency but also in terms of social protection.

Debt bondage is the focus of an international struggle for its abolition. Yet the literature finds that, in certain circumstances, the credit-for-work contracts behind debt bondage are mutually beneficial to both employer and employee. We take on an empirical study in south India to assess whether choosing credit, which can raise a risk of dependence on the lender and therefore a risk of debt bondage, is a choice made to prevent other forms of risk, especially financial risk and the risk of violence. We find this to be the case in our study. From a policy point of view, the abolition of debt bondage in these circumstances could drive up the very same forms of risk against which households seek to guard. In this context, providing alternatives employment solutions to rural workers is a priority. Copyright © 2016 John Wiley & Sons, Ltd.

This paper explains the observed hospital congestion in developing countries as the result of the interaction between ambulatory care physicians who refer patients to hospitals, and hospitals which must detect the severity of the incoming patients’ disease. In an imperfect information environment, physicians might refer to top-tier hospitals patients with mild diseases that could be properly addressed by regular hospitals, just to fulfill patients’ demand for the best care. Yet, the triage capability of top-tier hospitals declines if the hospital is subject to congestion, which, in turn, provides incentives to physicians to refer more patients to these hospitals. The model presents two equilibria, one with perfect triage, and another with triage errors and hospital congestion. In this last equilibrium, a higher hospital size raises the likelihood of congestion.

The aim of this article is to provide comparative population-based approach of the determinants of hospital use, in France 2012 and Québec 2011, with a focus on the frailty phenotype once netted out from other health and other covariates. We used comparable surveys of community-dwelling individuals matched with their National insurance claims and hospital episode records. Two-part models were used for access to hospital and length-of-stay. Our results suggest that ER use is more frequent in Québec while the hospitalization rate is lower in Québec after a venue at ER – suggesting that ER play the role of primary care in Québec. The length-of-stay is shorter in France where pay-for-performance scheme give hospital professionals the incentive to increase the number of inpatient care. We also found that frailty is associated with hospitalization through ER use in both countries, while the phenotype is neither associated with elective hospitalizations or the length-of-stay.

Although frailty is a well-known concept in the health science, its operational definition is still debated. From a diversity of models, two emerged in the early 2000 from epidemiological studies conducted in large population-based aging cohorts: the frailty phenotype (Fried 2001), and the frailty index (Rockwood 1994) measuring the accumulation of deficits and death. These tools have been applied as screening instruments in clinical settings to guide individual decision-making and orient treatments. New interrogations are raised by the use of instruments developed to screen frailty in epidemiological research for assessing individual situations. Open questions remain on the feasibility of frailty screening, the properties of screening tools, the relevance of an integration of socioeconomic dimensions in screening tools, and the effectiveness of interventions targeting frailty. This article presents an overview of current perspectives and issues around frailty screening in populations and in individuals.

Objective Hospital services use, which is a major driver of total health expenditures, is expected to rise over the next decades in Europe, especially because of population aging. The purpose of this article is to better understand the dynamics of older people's demand for hospital care over time in a cross-country setting. Data source We used data from the Survey on Health, Ageing, and Retirement in Europe (SHARE), in 10 countries between 2004 and 2011. Study Design We estimated a dynamic panel model of hospital admission for respondents aged 50 years or more. Principal Findings Following prior research, we found evidence of state dependence in hospital use over time. We also found that rise in frailty—among other health covariates—is a strong predictor of increased hospital use. Progression by one point on the frailty scale [0;5] is associated with an additional risk of about 2.1 percent on average. Conclusions Our results support promotion of early detection of frailty in primary care, and improvement of coordination between actors within the health system, as potential strategies to reduce avoidable or unnecessary hospital use among frail elderly.

International audience; Although a wide range of studies have tackled the outputs of social capital, fewer efforts have so far been dedicated to unveil its inputs. This study provides new empirical evidence on the determinants of social capital. The assumption to be tested is that the influence of “length of residence” on migrant’s social capital is different across host countries in Europe. The study makes use of data from the wave 2 of Survey of Health, Ageing, and Retirement in Europe (2006–2007) on individuals aged 50 or more in 14 European countries. Social capital is measured through two binary variables of participation in social activities and high generalized trust.

International audience; The objective of the present work is to explore the incremental costs of frailty associated with ambulatory health care expenditures (HCE) among the French population of community-dwellers aged 65 or more in 2012. We make use of a unique dataset that combines nationally representative health survey with respondents’ National Health Insurance data on ambulatory care expenditures. Several econometric specifications of generalized linear models are tested and an exponential model with gamma errors is eventually retained. Because frailty is a distinct health condition, its contribution to HCE was assessed in comparison with other health covariates (including chronic diseases and functional limitations, time-to-death, and a multidimensional composite health index). Results indicate that whatever health covariates are considered, frailty provides significant additional explanative power to the models. Frailty is an important omitted variable in HCE models. It depicts a progressive condition, which has an incremental effect on ambulatory health expenditures of roughly €750 additional euros for pre-frail individuals and €1500 for frail individuals.

International audience; The concept of frailty as a health dimension in old age is recent and has its origin in the development of geriatric medicine. Initially an unformulated clinical intuition, it is now defined by a diminished physiological reserve of multiple organs that exposes older individuals to increased vulnerability to stressors and a higher risk of adverse outcomes. The operational definition of frailty, however, is still debated. From a diversity of models, two emerged in the early 2000s from epidemiological studies conducted in large population-based aging cohorts. The body of research emphasized prospective associations between a frailty phenotype and a range of adverse outcomes or between a frailty index measuring the accumulation of deficits and death. A few studies showed promising spontaneous remissions in the early stages of frailty, raising expectations for effective interventions. Transitions between frailty stages and effective interventions on frailty nevertheless remain two fields needing further investigation. More recently, these tools have been applied as screening instruments in clinical settings to guide individual decision-making and orient treatments. New questions are raised by the use of instruments developed to screen frailty in epidemiological research for assessing individual situations. Inquiring whether frailty screening is relevant opens a Pandora's box of doubts and debates. There are many reasons to screen for frailty both from a public health and a clinical perspective that are only exacerbated by the current demographic evolution. Open questions remain about the feasibility of frailty screening, the properties of screening tools, the relevance of an integration of socioeconomic dimensions into screening tools, and the effectiveness of interventions targeting frailty. Fifteen years after the publication of the Fried and Rockwood landmark papers proposing operational definitions of frailty, this article presents an overview of current perspectives and issues around frailty screening in populations and in individuals.

International audience; ‘Active Ageing’ strategies aim to foster the participation of seniors in the society. Although economic literature has extensively studied the incentives for seniors to increase their labour supply, little is known about the motivations for older people to complement labour with other forms of social participation. This article provides empirical evidence of the role of intrinsic and extrinsic rewards received at work in the supply of formal and informal productive activities of 50- to 65-year-old workers. The results show that workers with higher levels of intrinsic rewards received at work, such as skill development opportunities and decision latitude, are more likely to participate in social activities outside the labour market. Extrinsic rewards on the other hand, like advancement perspectives, job security and pay, appear independent from both formal and informal social participation.

International audience; This study uses a time-based approach to examine the causal relationship (Granger-like) between health and social capital for older people in Europe. We use panel data from waves 1 and 2 of SHARE (the Survey of Health, Ageing, and Retirement in Europe) for the analysis. Additional wave 3 data on retrospective life histories (SHARELIFE) are used to model the initial conditions in the model. For each of the first 2 waves, a dummy variable for involvement in social activities (voluntary associations, church, social clubs, etc.) is used as a proxy for social capital as involvement in Putnamesque associations; and seven health dichotomous variables are retained, covering a wide range of physical and mental health measures. A bivariate recursive Probit model is used to simultaneously investigate (i) the influence of baseline social capital on current health - controlling for baseline health and other current covariates, and (ii) the impact of baseline health on current participation in social activities - controlling for baseline social capital and other current covariates. As expected, we account for a reversed causal effect: individual social capital has a causal beneficial impact on health and vice-versa. However, the effect of health on social capital appears to be significantly higher than the social capital effect on health. These results indicate that the sub-population reaching 50 years old in good health has a higher propensity to take part in social activities and to benefit from it. Conversely, the other part of the population in poor health at 50, may see their health worsening faster because of the missing beneficial effect of social capital. Social capital may therefore be a potential vector of health inequalities for the older population.

International audience; The aim of this paper is to measure and to correct for the potential incompa-rability of responses to the SHARE survey on health care responsiveness. A parametricapproach based on the use of anchoring vignettes is applied to cross-sectional data(2006–2007) in eleven European countries. More than 7,000 respondents aged 50 years oldand over were asked to assess the quality of health care responsiveness in three domains:waiting time for medical treatment, quality of the conditions in visited health facilities, andcommunication and involvement in decisions about the treatment. Our results suggest thatthere is reporting heterogeneity across countries and across individuals within countries,and the degree of heterogeneity varies with the health care domain. Although leadingcountries in terms of health care responsiveness remain among the most successful evenafter correction for reporting heterogeneity, one may acknowledge many shifts in theranking of the other countries.

International audience; This article is concerned with an empirical study of girls of the street in Mauritania. This study is original for three main reasons. First, it investigates Mauritania, a country where there have been very few studies of the phenomenon of children of the street. Secondly, it seems to us that though the academic literature on street children sometimes provides comparisons between girls and boys, very few studies focus specifically on girls of the street. Thirdly, the literature focusing on children of the street generally elucidates the mechanisms that lead some young people to live on the streets. On the contrary to previous literature, our study does not directly focus on mechanisms that lead some young people to live on the streets. Our study focuses on the question of the socio-economic determinants of the risk of violence. In other words, whereas the literature, following the hypothesis of aberrant families, uses violence as an explanatory factor for the phenomenon of children of the street, we attempt here to highlight the explanatory factors for the risk of violence and we treat this risk as an explained variable. A novel finding emerges from this study: there is less risk of violence facing girls of the street if the mother does not work. Conversely, the risk of violence is greater if the mother works and the father stays at home.

Cette etude propose de dresser un bilan de l’etat de sante des travailleurs âges entre 50 et 60 ans dans 14 pays europeens, a partir des donnees individuelles de l’enquete Share (2006-2007). L’analyse procede a des comparaisons internationales en s’appuyant sur plusieurs mesures de l’etat de sante – objectives et subjectives – , et pour lesquelles l’effet confondant des caracteristiques sociodemographiques est pris en compte. Bien que le recours a plusieurs mesures de sante ne permette pas de degager un schema europeen bien tranche, deux resultats principaux emergent. D’une part, on constate une importante heterogeneite des situations entre les pays d’Europe en matiere d’etat de sante des travailleurs de 50-59 ans. D’autre part, les actifs occupes francais comptent parmi les travailleurs de 50-59 ans les plus souvent en mauvaise sante.

L’objectif de cet article est de presenter et d’etayer empiriquement quelques elements d’analyse en faveur d’un vieillissement productif en dehors de la sphere marchande, generateur d’externalites positives pour la societe. A partir des donnees de panel de l’enquete Share 2004 et 2006 dans onze pays d’Europe et en s’interessant aux transitions entre ces deux periodes, il apparait que la retraite est le temps privilegie de la participation a des activites benevoles (organisations caritatives, clubs de sport, etc.). On observe egalement que lorsque l’engagement social court sur les deux periodes, la confiance generalisee est plus forte, ce qui laisse a penser que la participation sociale genere de la confiance. Or, cette confiance dans les autres est percue comme un determinant important de la performance economique des nations. En reconnaissant aux personnes âgees un role de producteur de cette confiance, au travers des activites benevoles realisees a la retraite, ce travail permet de reequilibrer quelque peu le debat stigmatisant le vieillissement de la population.

L’objectif de cet article est, premierement, d’identifier des determinants du depart a la retraite en Europe et, dans un deuxieme temps, d’essayer d’apprehender les differences entre les pays europeens. Nous utilisons les deux premieres vagues (2004-2006) de l’enquete Share, completees par des donnees provenant de l’OCDE. Nous avons choisi de regrouper les determinants selon trois spheres : individuelle, contextuelle et institutionnelle. En ce qui concerne la sphere individuelle, l’âge, la sante, le niveau d’etudes, la taille du menage importent dans la decision de partir en retraite. Pour la sphere contextuelle, les conditions de travail et la situation du conjoint sur le marche du travail sont aussi des determinants. Les trois domaines de la protection sociale (sphere institutionnelle), emploi, retraite, maladie, sont bien des facteurs importants qui pesent sur la decision de depart. Ces premiers resultats mettent en evidence le caractere multidimensionnel de la decision de partir en retraite. En ce qui concerne les differences entre les pays, nous mettons en evidence le fait que l’ensemble des determinants individuels et contextuels explique assez peu ces differences (15,5% des differences), contrairement aux trois systemes institutionnels (62,5%). Des lors, les differences entre les pays ne sont pas a chercher dans les differences entre les caracteristiques socio-economiques individuelles mais dans les particularites institutionnelles. Par consequent, toute politique publique qui aurait pour but une augmentation de taux d’emploi des seniors devrait reposer sur ces deux postulats : premierement, il faut tenir compte de la complexite des determinants des decisions individuelles et de leurs interactions ; deuxiemement, les principaux facteurs de convergence en Europe sont a rechercher dans les differences systemiques en prenant en consideration l’ensemble des systemes de protection.

Cet article propose un etat des lieux des evolutions conceptuelles et methodologiques qu’a recemment connu l’analyse de la pauvrete, jusqu’a aboutir a la notion de vulnerabilite. Il s’agit de montrer comment les avancees de la recherche ont permis de passer d’une approche ex-post a une approche exante des conditions de vie. Pour cela, une attention particuliere est donnee a l’analyse de la notion de risque comme etant au cœur de la relation qu’entretiennent dynamique de pauvrete et vulnerabilite. L’article propose un cadre d’analyse general afin d’introduire le lecteur aux methodes les plus recentes d’evaluation de la pauvrete, de la vulnerabilite et des concepts associes.

International audience; Elderly people facing dependence are exposed to the financial risk of long lasting care expenditures. This risk is high for people facing cognitive, functional and behavioral problems. In the short-term, dependent elderly people face increased non-medical care expenditures. In the long-term, they face increased medical care expenditures, which are driven by emergency care events such as: emergency hospitalization, emergency medical visits, and emergency institutionalizations. In France, providing public financial assistance has been shown to improve dependent people's access to non-medical care services. However, the impact of public financial assistance on emergency care use has not been explored yet. Our study aims at determining whether financial assistance on non-medical care provision decreases the probability of emergency care rates using data of 1131 French patients diagnosed with Alzheimer's disease, collected between 2003 and 2007. Using instrumental variables to deal with the presence of a potential endogeneity bias, we find that beneficiaries of long-term care subsidies have a significantly lower rate of emergency care than non-beneficiaries. Failing to control for endogeneity problems would lead to misestimate the impact of long-term care subsidies on emergency care rates. Finding that home care subsidies has a protective effect for emergency care confirmed the efficacy of this public policy tool.

International audience; As this comprehensive Companion demonstrates, social economics is a dynamic and growing field that emphasizes the key role that values play in the economy and in economic life. Social economics treats the economy and economics as being embedded in the larger web of social and ethical relationships. It also regards economics and ethics as essentially connected, and adds values such as justice, fairness, dignity, well-being, freedom and equality to the standard emphasis on efficiency. The Elgar Companion to Social Economics brings together the leading contributors in the field to elucidate a wide range of recent developments across different subject areas and topics. In so doing the contributors also map the likely trends and directions of future research. This Companion will undoubtedly become a leading reference source and guide to social economics for many years to come.

L’objectif de cet article est d’examiner les mecanismes institutionnels par lesquels le capital social favorise la gestion durable des ressources forestieres a Manjakatompo. L’article montre comment les differentes formes de capital social emergent au sein des reseaux de parente de Manjakatompo, et affectent positivement la durabilite de la gestion communautaire de la foret. Apres avoir analyse l’organisation des reseaux de parente, en tant que structure de gouvernance d’une part, etudie les specificites socioculturelles et institutionnelles de ces reseaux d’autre part, la production du capital social emanant de ces reseaux est examinee. Ce qui nous permet d’explorer le lien entre le capital social et la performance de la gestion communautaire et de la durabilite des ressources naturelles de cette region.

International audience; The aim of this study is to analyse the pathways between income and self-rated health through the mediating role of social capital. Taking up recent criticisms on statistical approaches to social capital, we propose to endogenize this concept as an outcome of households' economic status and personal characteristics. In this way it becomes possible to analyse both the compositional effect of social capital and its mediating role in the income-health causal pattern. The originality of this work rests on the production of two kinds of variables of social capital: the probability a household gets involved in social activities according to its characteristics; and a residual variable of social capital that is not predicated by household characteristics. Based on cross-sectional data from five rural areas of Antsirabe (Madagsacar) in 2001, this work suggests that a high level of social capital--especially in collective actions and social networks--leads to better self-rated health.

Support de la présentation de T.Rapp lors du séminaire Handicap et Dépendance du 12 mars 2015.L'objet du document de travail présenté ici est d'évaluer l'effet des subventions publiques françaises finançant le recours à l'aide à domicile (Allocation personnalisée d'autonomie, APA) sur la santé des personnes âgées dépendantes (mesurée par le taux de recours aux urgences). Un modèle de variable instrumentale est mise en oeuvre sur l'échantillon obtenu par l'expérience aléatoire Plasa (Plan de soins et d'aide dans la maladie d'Alzheimer, menée entre 2003 et 2007 au CHU de Toulouse). Les résultats montrent un effet négatif significatif de l'APA sur le taux d'hospitalisation.

International audience; Dans la théorie économique, la notion de fragilité peut être comprise à travers le modèle de demande de santé (Gross-man, 1972), selon lequel les agents investissent dans un véritable stock de capital santé qu’ils mobilisent tout au long de leur vie et plus particulièrement lorsqu’ils vieillissent...

This chapter considers the nature of the association between social participation and self-perceived health among older European adults. We examined the effect of the various combinations of participation in voluntary activities on older people’s self-rated health using SHARE data over the period 2004–2011 for 18 European countries and Israel. We found, on the whole, that taking part in social activities within the framework of voluntary organisations was indeed associated with a lower relative risk of reporting having had fair to poor health. At the same time, however, we found that participation in different forms of activities yielded unequal relationships with the health outcome. That is, not every activity or combination of activities contributed to health to the same degree. Exploring the drivers of heterogeneity in the relationship between health and volunteering in more depth, we found that the more activities older people get involved in, the better it is for their health, regardless of the types of activity.

Population aging increases the need to better understand the determinants of hospitalization in order to improve the quality of services. However, usual health measures often prove to be poorly predictive of hospitalization. The aim of this research is to determine whether physiological health measures designed for older adults, namely the Short Physical Performance Battery (SPPB) (Guralnik et al., 1994), frailty phenotypes (Fried et al., 2001), and profiles of functional decline (Lunney et al., 2003), are better predictors of hospital use. We use longitudinal data from the International Mobility in Aging Study (IMIAS), carried out between 2012 and 2014 in four countries (Canada, Brazil, Colombia, Albania) among individuals aged 65–74 at baseline (n=1724). Differences between health systems provide additional insights into the determinants of hospitalization. Health profiles from 2012, besides other confounders, are used to explain hospitalization in 2014. SPPB scores are computed using objective measures of gait speed, chair-stands, and balance. Frailty phenotype variables are created according to Fried’s classification into robust, pre-frail, and frail. Four profiles of functional decline are created: (1) terminal illness – cancer and at least one ADL disability; (2) organ failure – heart or lung disease and at least 2 ADL disabilities, (3) low reserve – stroke or more than 2 ADL disabilities, and (4) other respondents. Sample attrition is corrected by means of a Heckman selection Probit model. Our results indicate that a score below 8 on SPPB, the pre-frailty phenotype, and a profile of organ failure are significantly associated with hospitalization. Cross-country differences are discussed.

Le concept de fragilité de la personne âgée, bien que très populaire dans les études sur la perte d’autonomie, n’est pas univoque et sa mesure ne fait pas consensus. Même si l’on se réfère au modèle de Fried comme un cadre analytique commun, le choix des variables composant l’indice de fragilité n’est pas arrêté. Un des enjeux méthodologiques est de savoir si la mesure de la fragilité en population générale peut s’accommoder d’un certain degré de liberté dans la mise en oeuvre du recueil de l’information (choix des variables, modes de passation de l’enquête, etc.) ou si des mesures rigoureuses devraient être réalisées de manière identique dans chaque enquête. L’objectif de cette étude est de comparer les mesures de fragilité en France à partir de deux enquêtes en population générale. Deux questionnaires sont utilisés pour construire une mesure de fragilité, l’un propre à Survey of Health, Ageing and Retirement in Europe (SHARE), avec des mesures objectives et subjectives de santé, l’autre propre à l’Enquête santé et protection sociale (ESPS), avec des mesures uniquement déclarées. Les taux de prévalence de fragiles sont comparés entre les deux sources et les déterminants de la fragilité sont analysés. Nos résultats indiquent que la mesure de la fragilité et ses déterminants demeurent relativement stables pour des populations de 65 ans et plus, malgré une méthodologie d’enquête différente ; une certaine liberté dans le choix des variables est donc permise.

L’objectif de cette étude est d’analyser les déterminants du don de sang dans la population française en capacité de donner, âgée de 18 à 70 ans. La mise en oeuvre d’un questionnaire spécifique dans l’enquête ESPS permet, pour la première fois en France, de croiser des aspects relatifs au don de sang avec des variables économiques, sociales et de santé, en population générale. Des hypothèses issues de la théorie économique et relatives à la dimension normative de l’acte de don (altruisme, mimétisme social, etc.) ont été avancées et le rôle de l’aversion au risque, jusqu’alors absente des études, a été pris en compte. Les résultats montrent que les donneurs actifs sont en général des individus plus altruistes, avec des niveaux plus élevés de participation à des activités sociales, mais aussi, toutes choses égales par ailleurs, sont des individus qui ont une plus grande propension à prendre des risques que les autres. Les implications de ces résultats pour la conduite de la stratégie de collecte de sang sont discutées.

Les études récentes sur la demande de soins de long terme ont mis en évidence le rôle de la fragilité en tant que précurseur de la perte d’autonomie, indépendamment des maladies chroniques. La fragilité est définie comme un état de santé vulnérable résultant de la diminution de la réserve physiologique de la personne âgée. Ce concept médical est introduit ici dans un cadre d’analyse économique afin d’étudier le rôle des politiques sociales dans la prévention de la perte d’autonomie et le maintien de la qualité de vie des personnes en perte d’autonomie. En utilisant quatre vagues de données de panel de l’enquête SHARE (Survey on Health, Ageing, and Retirement in Europe), un indice de fragilité est créé comme métrique de cinq critères physiologiques (modèle de Fried) pour des répondants âgés de 50 ans et plus dans dix pays européens, entre 2004 et 2011. La dimension longitudinale est explorée de deux manières. Premièrement, les différences dans l’évolution de la fragilité sur une période de sept ans sont analysées à partir de variables pertinentes pour la politique sociale (soutien au revenu, aménagement du logement et prévention de l’isolement social) dans un modèle de panel à effets fixes. Deuxièmement, les effets fixes individuels sont décomposés grâce à un modèle à effets aléatoires avec une spécification à la Mundlak. Les données rétrospectives supplémentaires de SHARE sur l’histoire de vie (SHARELIFE) sont ensuite utilisées pour examiner les différences entre les niveaux de fragilité. Les résultats révèlent la présence de plusieurs sources d’inégalités sociales au cours de la vie. Il s’avère donc que les systèmes de protection sociale jouent un rôle majeur dans l’accompagnement, la prévention ou la réduction du processus de perte d’autonomie. Plusieurs implications pour les politiques publiques sont suggérées.