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Introduction Les etrangers en situation irregulieres en France sont inegalement touches par les maladies infectieuses en lien avec les pays d’origine mais aussi les mauvaises conditions d’accueil. Cependant, bien que les maladies infectieuses ressortent comme un des premiers motifs de consultations dans les structures d’accueil socio-sanitaire, aucune etude n’a a ce jour evalue la frequence de ces maladies infectieuses dans un echantillon non selectionne d’etrangers en situation irreguliere. Materiels et methodes L’enquete Premiers Pas est une enquete epidemiologique transversale realisee aupres d’un echantillon aleatoire (plan de sondage a 2 degres) d’etrangers en situation irregulieres recrutes a Paris et dans l’agglomeration de Bordeaux dans des lieux et structures susceptibles d’etre frequentes par des personnes sans titre de sejour. Les pourcentages ont ete ponderes. L’analyse a ete realisee a l’aide du logiciel Stata 15.0. Resultats Au total, 1223 etrangers sans titre de sejour ont ete recrutes dans 63 lieux et structures (selectionnes parmi 736 lieux et structures). L’entretien s’est deroule en francais dans 75 % des cas. L’echantillon etait compose d’hommes a 65 %, âges de 30 a 40 ans (36 %), originaires d’Afrique subsaharienne (63 %), d’Afrique du Nord (24 %) ou d’Amerique (6 %) ; 38 % etaient arrives en France depuis moins d’un an et 22 % depuis plus de 5 ans. Parmi les participants, 24,8 % declaraient un mauvais ou tres mauvais etat de sante percu, 33,5 % un probleme de sante chronique et 68,2 % un probleme de sante au moment de l’enquete. Mis a part les infections dentaires (caries, infection ou douleur) qui concernaient 43,2 % des participants, 12,9 % des repondants ont declare souffrir d’une maladie infectieuse : infection par le VIH (3,5 %), infection chronique par le VHB (3,1 %), infection de la sphere ORL (1,7 %), mycose cutanee (1,2 %), infection de la peau et des tissus mous (0,8 %), infection par le VHC (0,8 %), infection urinaire (0,7 %), infection bronchopulmonaire (0,7 %), gale (0,3 %), tuberculose maladie (0,2 %), mycose vaginale 0,6 % et herpes 0,1 %. Concernant les infections par le VIH, le VHB et le VHC, 56 %, 71 % et 89 % respectivement declaraient avoir ete diagnostiques apres leur arrivee en France. C’etait egalement le cas des quelques cas de tuberculose maladie. En analyse multivariee, le risque d’etre atteint d’une virose chronique etait plus frequent parmi les participants les plus jeunes, arrives en France depuis moins de 3 ans, originaires d’Afrique ou d’Amerique du Sud, en situation d’insecurite alimentaire et recrutes dans les associations ou les structures de soins primaires. Conclusion Cette etude originale aupres d’un echantillon tendant vers la representativite confirme la frequence des maladies infectieuses chez les personnes etrangeres sans papiers en France et l’importance d’integrer leur depistage et leur prise en charge dans une logique plus globale d’acces aux soins precoce et de prise en charge inclusive medico-psychosociale.

Background For financial reasons, dental prosthetics is one of the major unmet dental healthcare needs [Financial-SUN (F-SUN)]. Private fees for dental prosthetics result in significant out-of-pocket payments for users. This study analyzes the impact of geo-variations in protheses fees on dental F-SUN. Methods Using a nationwide French declarative survey and French National Health Insurance administrative data, we empirically tested the impact of prosthetic fees on dental F-SUN, taking into account several other enabling factors. Our empirical strategy was built on the homogeneous quality of the dental prosthesis selected and used to compute our price index. Results Unmet dental care needs due to financial issues concern not only the poorest but also people with middle incomes. The major finding is the positive association between dental fees and difficulty in gaining access to dental care when other enabling factors are taken into account (median fee in the highest quintile: OR = 1.35; P value = 0.024; 95% CI 1.04–1.76). People with dental F-SUN are those who have to make a greater financial effort due to a low/middle income or a lack of complementary health insurance. For identical financial reasons, the tendency to give up on healthcare increases as health deteriorates. Conclusions The results underscore the need for fee regulation regarding dental prosthetics. This is in line with the current French government dental care reform.

This article explores illegal migration routes and groups across North Africa to Europe. We describe sub-Saharan and cross-Mediterranean routes, and how they changed during the years. We propose an analytical framework for the main factors for these migrations, from local to international and regulatory context. We then describe sea-migrants' nationalities and socio-economic and demographic characteristics, from studies undertook in Tunisia and Morocco. While boat migration represents only a fraction of illegal migration to Europe, it raises humanitarian as well as ethical issues for European and North African (NA) countries, as a non-negligible amount of them end up in death tolls of shipwrecks in the Mediterranean Sea. Moreover, existing statistics show that illegal trans-Mediterranean migration is growing exponentially. Ongoing crises in Africa and the Middle East are likely to prompt even larger outflows of refugees in the near future. This should induce NA countries to share closer public policy concerns with European countries.

In recent years, North African (NA) countries ceased to be emigration-only countries and are now on the verge of becoming immigration as well as transit countries for economic migrants and refugees. Contextual as well as structural long-term factors are driving these changes. The ongoing crises in Africa and the Middle East are prompting strong outflows of refugees, which are likely to induce NA countries to share some common public policy and public health concerns with European countries in a near future. This article highlights some aspects of these changes, from the study of the consequences of the 2011 Libyan crisis in Tunisia. It addresses individual trajectories and health concerns of refugees in and out North Africa from a study of the Choucha camp in Tunisia. The camp opened to immigrants from Libya during the 2011 crisis and accommodated the bulk of the refugees flow to Tunisia until July 2012. The study includes a monographic approach and a qualitative survey in the Choucha camp refugees. We describe the crisis history and the health response with a focus on the camp. We then address refugees' trajectories, and health needs and concerns from the interviews we collected in the camp in April 2012.

In 2005, France implemented a gatekeeping reform designed to improve care coordination and to reduce utilization of specialists’ services. Under this policy, patients designate a médecin traitant, typically a general practitioner, who will be their first point of contact during an episode of care and who will provide referrals to specialists. A key element of the policy is that patients who self-refer to a specialist face higher cost sharing than if they received a referral from their médecin traitant. We consider the effect of this policy on the utilization of physician services. Our analysis of administrative claims data spanning the years 2000–2008 indicates that visits to specialists, which were increasing in the years prior to the implementation of the reform, fell after the policy was in place. Additional evidence from the administrative claims as well as survey data suggest that this decline arose from a reduction in self-referrals, which is consistent with the objectives of the policy. Visits fell significantly both for specialties targeted by the policy and specialties for which self-referrals are still allowed for certain treatments. This apparent spillover effect may suggest that, at least initially, patients did not understand the subtleties of the policy.

International audience; This article focusses on self-assessed unmet needs for financial reasons. We study its social and economic determinants and its consequences on future health status, from a longitu-dinal dataset: the French Heath, Health care and Insurance Survey (Enquête Santé Protection Sociale). We first show that living standards, access to complementary health insurance and life course factors (past, current and anticipated socioeconomic status) have an impact on self-assessed unmet needs. We then show that self-assessed unmet needs have a detrimental causal effect on future health status,suggesting that financial barriers in access to health care contribute to social health inequalities.; Cet article propose d’analyser des déterminants du renoncement aux soins pour raisons financières puis d’étudier ses conséquences sur l’évolution de l’état de santé quatre ans plus tard à partir des données de l’Enquête Santé ProtectionSociale. L’analyse des déterminants du renoncement montre le rôle important joué par l’accès à une couverture complémentaire, au côté de celui de la situation sociale présente, passée et anticipée. L’analyse montre ensuite que le renoncement aux soins a un effet causal sur la dégradation de l’état de santé ultérieur. Elle suggère ainsi que les difficultés d’accès aux soins contribuent aux inégalités de santé.

Background Understanding interactions between patients and GPs may be important for optimising communication during consultations and improving health promotion, notably in the management of cardiovascular risk factors. Aim To explore the agreement between physicians and patients on the management of cardiovascular risk factors, and whether potential disagreement is linked to the patient9s educational level. Design of study INTERMEDE is a cross-sectional study with data collection occurring at GPs9 offices over a 2-week period in October 2007 in France. Method Data were collected from both patients and doctors respectively via pre- and post-consultation questionnaires that were ‘mirrored’, meaning that GPs and patients were presented with the same questions. Results The sample consisted of 585 eligible patients (61% females) and 27 GPs. Agreement between patients and GPs was better for tangible aspects of the consultation, such as measuring blood pressure (κ = 0.84, standard deviation [SD] = 0.04), compared to abstract elements, like advising the patient on nutrition (κ = 0.36, SD = 0.04), and on exercise (κ = 0.56, SD = 0.04). Patients9 age was closely related to level of education: half of those without any qualification were older than 65 years. The statistical association between education and agreement between physicians and patients disappeared after adjustment for age, but a trend remained. Conclusion This study reveals misunderstandings between patients and GPs on the content of the consultation, especially for health-promotion outcomes. Taking patients9 social characteristics into account, notably age and educational level, could improve mutual understanding between patients and GPs, and therefore, the quality of care.

Cet article etudie les liens existant entre nationalite, migration et etat de sante a partir des donnees de l’enquete decennale Sante menee en 2002-2003 en France. Les resultats montrent l’existence d’inegalites face a la sante des personnes d’origine etrangere, liees a l’existence d’un effet de selection a la migration compense a long terme par un effet deletere de la migration, explique en partie seulement par la situation sociale difficile des immigres en France. Cette analyse suggere egalement un effet non negligeable a long terme des caracteristiques economiques et sanitaires du pays de naissance, propre a expliquer les disparites d’etat de sante observees au sein de la population immigree.

We study the psycho-social determinants of self-assessed health in order to explain social inequalities in health in France. We use a unique general population survey to assess the respective impact on self-assessed health status of subjective perceptions of social capital, social support, and sense of control, controlling for standard socio-demographic factors (SES, income, education, age, and gender). The survey is unique in that it provides a variety of measures of self-perceived psycho-social resources (trust and civic engagement, social support, sense of control, and self-esteem). We find empirical support for the link between the subjective perception of psycho-social resources and health. Sense of control at work is the most important correlate of health status after income. Other important ones are civic engagement and social support. To a lesser extent, sense of being lower in the social hierarchy is associated with poorer health status. On the contrary, relative deprivation does not affect health in our survey. Since access to psycho-social resources is not equally distributed in the population, these findings suggest that psycho-social factors can partially explain of social inequalities in health in France.

L’enquete SHARE (Survey on Health, Ageing and Retirement in Europe) est une operation internationale et multidisciplinaire, lancee en 2002, conduite par un reseau europeen coordonne par le MEA (Mannheim Economics of Aging) de l’Universite de Mannheim. Elle a l’ambition de devenir un instrument de reference pour les travaux pluridisciplinaires sur le vieillissement. Un test de cette enquete sur environ 12000 menages a eu lieu dans dix pays europeens en 2004. Cette premiere vague devrait deja permettre la realisation de nombreux travaux comparatifs ou microeconometriques puisque les donnees ont ete rendues accessibles aux chercheurs au printemps 2005, apres publication d’un volume de premiers resultats. Cet article presente l’enquete et donne un apercu de ses potentialites, a l’aide de quelques premiers resultats descriptifs pour la France.

Context Several studies provide evidence of horizontal inequities in health care use in France, i.e. differences in health care utilization for equal needs in favor of the highest socioeconomic groups [1-3]. Similarly, significant social inequalities in mortality have been found in France in comparison with other European countries [4]. However, the contribution of inequity in access to care to health inequalities is disputable and the consequences in term of health status and future health care consumption of horizontal inequities in health care use have scarcely been explored.

The Institut de Recherche et Documentation en Economie de la Sante (IRDES) Workshop on Applied Health Economics and Policy Evaluation aims at disseminating health economic research's newest findings and enhancing the community's capacity to address issues that are relevant to public policy. The 2010 program consisted of 16 articles covering a vast range of topics, such as health insurance, social health inequalities and health services research. While most of the articles embedded theoretical material, all had to include empirical material in order to favor more applied and practical discussions and results. The 2010 workshop is to be the first of a series of annual workshops in Paris gathering together researchers on health economics and policy evaluation. The next workshop is to be held at IRDES in June 2011.

Background The way in which patients and their doctors interact is a potentially important factor in optimal communication during consultations as well as treatment, compliance and follow-up care. The aim of this multidisciplinary study is to use both qualitative and quantitative methods to explore the 'black box' that is the interaction between the two parties during a general practice consultation, and to identify factors therein that may contribute to producing health inequalities. This paper outlines the original multidisciplinary methodology used, and the feasibility of this type of study. Methods and design The study design combines methodologies on two separate samples in two phases. Firstly, a qualitative phase collected ethnographical and sociological data during consultation, followed by in-depth interviews with both patients and doctors independently. Secondly, a quantitative phase on a different sample of patients and physicians collected data via several questionnaires given to patients and doctors consisting of specific 'mirrored' questions asked post-consultation, as well as collecting information on patient and physician characteristics. Discussion The design and methodology used in this study were both successfully implemented, and readily accepted by doctors and patients alike. This type of multidisciplinary study shows great potential in providing further knowledge into the role of patient/physician interaction and its influence on maintaining or producing health inequalities. The next challenge in this study will be implementing the multidisciplinary approach during the data analysis.

Study objective: Since January 2005 France is exploring a new scheme termed "preferred doctor" (médecin traitant) which can be considered as an innovative version of Gate Keeping in order to reduce the excess of postulated excess in health consumption, more especially access to specialist care. This paper describes the political process which lead to it's implementation, tries to relate some of the scheme specific features with it's results after one year implementation and tries to catch a glimpse for the next steps of the reform. Material and methods: In order to measure the scheme impact on the "patient treatment pathway" and on physician income, we used a sample of 7198 individual from the 2006 "French health, Health Care and Insurance Survey "(ESPS),"including health, socioeconomic and insurance status and through a set of questions relating to patient's understanding of the scheme and different data bases of the national sickness fund as well as different studies done by regulatory agencies. Results and discussion: First results after one year implementation show that most patients chose a preferred doctor, who in a vast majority happened to be their family doctor. A vast majority of patients also considered the scheme as mandatory. Impact on access to specialist care, as measured through self assessed unmet need for specialist care, appears not negligible, especially for the less well off and those not covered by a complementary insurance. In term of financial impact, the new constraints on access to ambulatory care seem to have been offset by rises in the fee schedules for the specialities which lost direct access We discuss why these short term weak outcomes are linked with a wicked system of the health system governance and to the political and professional context in which the scheme unfolded strongly and determined its structure and implementation pathway. On a more long range perspective, we analyse how the new scheme may nevertheless lead up to reinforced managed care reforms.

Cet article étudie les liens existant entre nationalité, migration et état de santé à partir des données de l'Enquête décennale Santé menée en 2002-2003 en France. Les résultats montrent l'existence d'inégalités face à la santé des personnes d'origine étrangère, liées à l'existence d'un effet de sélection à la migration compensé à long terme par un effet délétère de la migration, expliqué en partie seulement par la situation sociale difficile des immigrés. Cette analyse suggère également un effet non négligeable à long terme des caractéristiques économiques et sanitaires du pays de naissance, propre à expliquer les disparités d'état de santé observées au sein de la population immigrée.

We study the psychosocial determinants of health, and their impact on social inequalities in health in France. We use a unique general population survey to assess the respective impact on self-assessed health status of subjective perceptions of social capital controlling for standard sociodemographic factors (occupation, income, education, age and gender). The survey is unique for two reasons: First, we use a variety of measures to describe self-perceived social capital (trust and civic engagement, social support, sense of control, and self-esteem). Second, we can link these measures of social capital to a wealth of descriptors of health status and behaviours. We find empirical support for the link between the subjective perception of social capital and health. Sense of control at work is the most important determinant of health status. Other important ones are civic engagement and social support. To a lesser extent, sense of being lower in the social hierarchy is associated with poorer health status. On the contrary, relative deprivation does not affect health in our survey. Since access to social capital is not equally distributed in the population, these findings suggest that psychosocial factors can explain a substantial part of social inequalities in health in France.

Sind internationale Vergleiche des subjektiven Gesundheitszustands relevant? Eine Evaluierung anhand der Vignetten-und NormenmethodeVerwenden die Interviewten die Modalitäten der Beantwortung einer Frage mit subjektiver Bewertung unterschiedlich, werden diese von einem "Item-Bias“ oder von einem Effekt des Typs DIF (Differential Item Functioning) beeinträchtigt. Die Antworten müssen dann korrigiert werden, bevor sie zur Erstellung komparativer Hypothesen über den subjektiven Gesundheitszustand von Unterpopulationen verwendet werden können. Bei dieser Studie stellen wir eine Methode zur Feststellung und Korrektur von DIF-Effekten in der Selbstbeurteilung der subjektiven Gesundheit vor. Diese Methode basiert auf der Bewertung durch die Individuen von Gesundheitszuständen, die fi ktiven Situationen "so genannten Vignetten-Normen "entsprechen. Sie besteht daran, die Antwort eines Individuums auf eine subjektive Frage durch die Evaluierungen zu "kalibrieren“, denen es in verschiedenen Vignetten beschriebene Situationen unterzieht. Sie setzt voraus, dass sich alle Individuen bei der Beantwortung subjektiver Fragen auf ein und dieselbe Gesundheitsdimension beziehen, dass sie die Vignetten und ihre eigene Situation auf vergleichbare Weise beurteilen, dass die Vignetten vom Analysten im Voraus und eindeutig nach der untersuchten Gesundheitsdimension geordnet werden können. Eine potenzielle DIF-Verzerrung kann identifi ziert werden, indem die Verteilung der Evaluierungen der Vignetten in beiden Untergruppen von Individuen verglichen wird. Sie kann korrigiert werden, indem die Antwort eines jeden Individuums auf die Frage der subjektiven Bewertung im Verhältnis zu seinen Evaluierungen der in den Vignetten beschriebenen Situationen positioniert wird. Die Berücksichtigung von Kohärenzproblemen führt zur Erstellung von Unsicherheitsintervallen für die Werte der betreffenden Variablen. Die vorgeschlagene Methode wird anhand des Aufzeigens eines möglichen DIF-Effekts bei der Eigenbewertung des körperlichen Schmerzes je nach geographischer Herkunft der Stichproben aus der Erhebung Share 2004 veranschaulicht, die uns insbesondere veranlassen würde, unseren Vergleich der subjektiven Gesundheit der schwedischen und der niederländischen Stichproben zu ändern., Are International Comparisons of Subjective States of Health Relevant? An Evaluation Using the Standard Vignettes Method. When the response modalities for a question which is evaluated subjectively are used in different ways by respondents, it is said that the modalities are affected by an "item bias” or by a DIF (Differential Item Functioning)-type effect. The responses must in this case be corrected before they can be used to formulate comparative hypotheses on the subjective state of health of sub-populations. We present a detection and correction method for DIF effects in self-assessments of subjective health in this paper. This method is based on individuals’assessments of states of health which correspond to imaginary situations, called standard vignettes. It entails •calibrating” an individual’s response to a subjective question using the assessments he or she makes of situations described in different vignettes. It supposes that all the individuals refer to a single aspect of health when responding to subjective questions, that they assess the vignettes and their own situation in comparable ways, and that the vignettes can be a priori and unambiguously ordered by the analyst, according to the aspect being analysed. A potential DIF bias can be identifi ed by comparing the distribution of the assessments made of the vignettes by two sub-groups of individuals. It can be corrected by positioning each individual’s response to the subjectively assessed question in relation to his or her assessments of situations described in the vignettes. Taking into account coherence problems leads to the establishment of uncertainty intervals for the values of the variable which is produced in this way. The proposed method is illustrated by highlighting a possible DIF effect in the self-assessment of physical pain, according to the geographical origin of samples from the Share 2004 survey, which would particularly lead us to modify our comparison of subjective states of health in the Swedish and Dutch samples., Lorsque les modalités de réponse à une question d'évaluation subjective sont utilisées différemment par des répondants, on dit que celles-ci sont affectées par un « biais d'item » ou par un effet de type DIF (Differential Item Functioning). Les réponses doivent alors être corrigées avant de pouvoir être utilisées pour formuler des hypothèses comparatives sur l'état de santé subjectif de sous-populations. Nous présentons dans ce travail une méthode de détection et de correction d'effets DIF dans les auto-évaluations de santé subjective. Cette méthode est basée sur l'évaluation par les individus d'états de santé correspondant à des situations fictives, appelées vignettes-étalons. Elle consiste à « étalonner » la réponse d'un individu à une question subjective par les évaluations qu'il fait de situations décrites dans différentes vignettes. Elle suppose que tous les individus se réfèrent à une même dimension de santé en répondant aux questions subjectives, qu'ils évaluent de façon comparable les vignettes et leur propre situation, que les vignettes puissent être ordonnées a priori et sans ambiguïté par l'analyste, selon la dimension de santé étudiée. Un biais DIF potentiel peut être identifié en comparant la répartition des évaluations des vignettes dans deux sous-groupes d'individus. Il peut être corrigé en positionnant la réponse de chaque individu à la question d'évaluation subjective par rapport à ses évaluations des situations décrites dans les vignettes. La prise en compte de problèmes de cohérence conduit à construire des intervalles d'incertitude pour les valeurs prises par la variable ainsi obtenue. La méthode proposée est illustrée par la mise en évidence d'un possible effet DIF dans l'auto-évaluation de la douleur physique, selon l'origine géographique des échantillons issus de l'enquête Share 2004, qui nous conduirait en particulier à modifier notre comparaison des états de santé subjectifs des échantillons suédois et néerlandais., ¿ Son pertinentes las comparaciones internacionales sobre estado de salud subjetivo? Una evaluación por el método de viñetas-patronesCuando los encuestados utilizan las modalidades de respuesta a una pregunta de evaluación subjetiva de manera diferente, decimos que éstos están afectados por un "sesgo de ítem” o por un efecto de tipo DIF (Differential Item Functioning). En estos casos, las respuestas deben corregirse antes de poder utilizarse para formular hipótesis comparativas sobre el estado de salud subjetivo de subpopulaciones. En este trabajo, presentamos un método de detección y corrección de efectos DIF en las autoevaluaciones. Este método se basa en la evaluación por los individuos de estados de salud relativos a situaciones fi cticias, denominadas viñetas-patrones. Este consiste en "establecer patrones” sobre la respuesta de un individuo a una pregunta subjetiva por las evaluaciones que hace de las situaciones descritas en las diferentes viñetas. Supone que todos los individuos se refi eran a una misma dimensión de salud cuando responden a las preguntas subjetivas, que evalúen de manera comparable las viñetas y su propia situación, que el analista pueda ordenar a priori y sin ambigüedad las viñetas según la dimensión de salud estudiada. Un sesgo DIF potencial puede ser identifi cado comparando la repartición de las evaluaciones de las viñetas en dos subgrupos de individuos. Puede corregirse colocando la respuesta de cada individuo a la pregunta de evaluación subjetiva respecto a sus evaluaciones de las situaciones descritas en las viñetas. Considerar los problemas de coherencia conlleva la creación de intervalos de incertidumbre para los valores tomados por la variable así obtenida. El método propuesto se ilustra por la evidenciación de un posible efecto DIF en la auto-evaluación del dolor físico, según el origen geográfi co de los muestreos procedentes de la encuesta Share 2004, que nos obligaría, en particular, a modifi car nuestra comparación de los estados de salud subjetivos de los muestreos suecos y holandeses., Lardjane Salim, Dourgnon Paul. Les comparaisons internationales d'état de santé subjectif sont-elles pertinentes ? Une évaluation par la méthode des vignettes-étalons. In: Economie et statistique, n°403-404, 2007. Santé, vieillissement et retraite en Europe. pp. 165-177.

Reviewing recent debates on the measurement of health inequalities, the authors found first of all that the variety of tools used attests not only to the different contexts, data and goals, but also to the methodologies that are specific to the disciplines that dealt with this field, more particularly social epidemiology and health economics. In particular, it was observed that the paucity of objective data on health status (allowing theoretically for spatial and temporal comparisons) and of cardinal data (allowing for direct comparison of individual situations) in the surveys of the general population led to painstaking methodological research on the transition from the ordinal to the cardinal and on the correction of socioeconomic or cultural biases in health status reporting. Noting that the measurement of economic and social status poses the same type of problems, they underlined the relevance of decomposition methods that take account of several explanatory factors at the same time. This article illustrates the links between measuring instruments and social justice standards by pointing out the elements for debate on the measurement of pure inequalities or social inequalities in health. Lastly, the authors found that the goal of equity is not displayed clearly enough in the choices of tools used to measure health inequalities. It is concluded that the link between theories of social justice and tools used to measure health inequalities should be strengthened., Parcourant les débats récents sur la mesure des inégalités de santé, les auteurs relèvent tout d’abord que la variété des outils témoigne de contextes, données et objectifs différents, mais aussi de méthodologies propres aux disciplines qui ont investi ce champ, plus particulièrement l’épidémiologie sociale et l’économie de la santé. Ils constatent en particulier que la rareté des données d’état de santé objectives (permettant théoriquement les comparaisons dans l’espace et dans le temps) et cardinales (rendant possible la comparaison directe des situations individuelles) dans les enquêtes en population générale a entraîné un important effort de recherche méthodologique sur le passage de l’ordinal au cardinal et sur la correction des biais socioéconomiques ou culturels de déclaration de l’état de santé. Remarquant que la mesure du statut économique et social pose des difficultés du même ordre, ils soulignent l’intérêt des méthodes de décomposition qui prennent en compte plusieurs facteurs explicatifs simultanément. L’article illustre les liens entre instruments de mesure et normes de justice sociale en relevant des éléments de débat portant notamment sur la mesure d’inégalités pures ou d’inégalités sociales de santé. Enfin, l’objectif d’équité apparaît aux auteurs insuffisamment clairement affiché dans les choix d’outils de mesure des inégalités de santé. Ils concluent à la nécessité de renforcer le lien entre théories de la justice sociale et outils de mesure des inégalités de santé., Couffinhal Agnès, Tubeuf Sandy, Dourgnon Paul. Outils de mesure des inégalités de santé : quelques débats d’actualité. In: Santé, Société et Solidarité, n°2, 2004. Inégalités sociales de santé. pp. 163-171.

recourir aux generalistes ou aux specialistes. Apres ajustement sur lesconditions socioeconomiques, le recours aux soins des immigres n’est plussignificativement different de la population franc¸aise. L’analyse en decomposi-tion montre que les principales barrieres a l’acces aux soins des immigres sontleur faibleacces a la complementaire sante, leurs plus faibles revenuset niveauxd’education.Discussion.– Les resultats montrent que le principe d’equite horizontale dansl’acces aux soins n’est pas respecte en France et appellent la mise en œuvre depolitiques de sante publiquevisant a ameliorer l’accesaux soins des populationsd’origine etrangere en simplifiant, par exemple, l’acces aux droits a l’aidemedicale d’Etat et de la couverture-maladie universelle.http://dx.doi.org/10.1016/j.respe.2013.03.031