1. The Characteristics of Care Provided to Population(s) in Precarious Situations in 2015. A Preliminary Study on the Universal Health Cover in France
- Author
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Philippe Boutin, Emilie Bouquet, Marie-Christine Pérault-Pochat, François Birault, Bérangère Thirioux, Nicole Caunes, Stéphanie Mignot, Pinet, Nicolas, Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers, Pôle de Santé Des Couronneries, Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire de neurosciences expérimentales et cliniques (LNEC), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), and Centre Hospitalier Henri Laborit (CHL)
- Subjects
Chronic bronchitis ,medicine.medical_specialty ,Inequality ,Health, Toxicology and Mutagenesis ,media_common.quotation_subject ,Population ,lcsh:Medicine ,Burnout ,Drug Prescriptions ,Vulnerable Populations ,Article ,03 medical and health sciences ,reimbursed drugs prescriptions ,0302 clinical medicine ,General Practitioners ,Universal Health Insurance ,Environmental health ,Health care ,Epidemiology ,medicine ,Humans ,030212 general & internal medicine ,education ,Reimbursement ,media_common ,Retrospective Studies ,universal health cover ,general practice ,education.field_of_study ,Physician-Patient Relations ,[SDV.MHEP] Life Sciences [q-bio]/Human health and pathology ,business.industry ,lcsh:R ,Public Health, Environmental and Occupational Health ,3. Good health ,Defined daily dose ,030221 ophthalmology & optometry ,precarious populations ,France ,business ,Delivery of Health Care ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
Background: The French Universal Health Cover (CMU) aims to compensate for inequalities between precarious and non-precarious populations, enabling the former to access to free healthcare. These measures rely on the principle that precarious populations&rsquo, health improves if healthcare is free. We designed a study to examine whether CMU fails to compensate for inequalities in reimbursed drugs prescriptions in precarious populations. Material and method: This retrospective pharmaco-epidemiological study compared the Defined Daily Dose relative to different reimbursed drugs prescribed by general practitioners (GPs) to precarious and non-precarious patients in France in 2015. Data were analysed using Mann&ndash, Whitney tests. Findings: 6 out of 20 molecules were significantly under-reimbursed in precarious populations. 2 were over-reimbursed. The 12 remaining molecules did not differ between groups. Interpretation: The under-reimbursement of atorvastatin, rosuvastatin, tamsulosine and timolol reflects well-documented epidemiological differences between these populations. In contrast, the equal reimbursement of amoxicillin, pyostacine, ivermectin, salbutamol and tiopropium is likely an effect of lack of compensation for inequalities. Precarious patients are more affected by diseases that these molecules target (e.g., chronic bronchitis, bacterial pneumonia, cutaneous infections). This could also be the case for the equal and under-reimbursement of insulin glargine and metformin (targeting diabetes), respectively, although this has to be considered with caution. In conclusion, the French free healthcare cover does not fail to compensate for all but only for some selective inequalities in access to reimbursed drugs prescriptions. These results are discussed with respect to the interaction of the doctor&ndash, patient relationship and the holistic nature of primary care, potentially triggering burnout and empathy decrease and negatively impacting the quality of care in precarious populations.
- Published
- 2020