Publications by PSE researchers

Background Testing for COVID-19 has been strongly recommended for individuals experiencing COVID-19-like symptoms or those with a close relative who tested positive. In France, tests were free of charge until mid-October 2021 and became widely available after June 2020. Our main objective was to investigate whether access to COVID-19 testing in France was associated with socio-economic conditions, considering gender and ethno-racial status. Methods A random population-based cohort survey was conducted in France in May 2020 and November 2020, including 95,388 participants aged 18 and over. We used logistic regressions to identify how having been tested in 2020 was associated with socio-economic status and exposure factors among two groups of individuals. The first group consisted of individuals who had no close relative test positive but reported experiencing Covid-19-like symptoms, such as cough, fever, dyspnea, or sudden onset of ageusia, dysgeusia, or anosmia (N=12,729). The second group included individuals, with or without symptoms, who reported that a close relative had tested positive for Covid-19 (N=5,360). Findings In both groups, testing was more frequent among individuals living in urban areas. For individuals who had no close relative test positive but reported Covid-19-like symptoms, women were 1.04 (95%CI [1.01-1.06]) more likely than men to be tested, and testing decreased with age up to 35. Individuals holding a university degree were 1.08 [1.04-1.12]) more likely than those who only completed high school to be tested, as well as those in one of the three top income deciles with reference to the bottom decile (OR 1.07, [1.02-1.13] for the top decile). Ethno-racial status was not significantly associated with testing. For respondents who had a close relative test positive, testing was strongly associated with having experienced some symptoms, especially after September 1 (OR 1.34, 95%CI [1.30-1.39]). However, there was no link between testing and income, education, or ethno-racial status. Interpretation When an individual experiences symptoms but has no close relative who is positive, the motivation to test to avoid transmitting the virus to relatives by isolating oneself is particularly strong. This strategy makes sense when there are actual possibilities to isolate, which may explain why higher income and education positively impact the propensity to test. For individuals who had a close relative test positive, most socio-economic variables were no longer related to testing once infection risk was controlled for. The availability of tests at no cost is not sufficient in itself to eliminate socio-economic inequalities in testing.

The COVID-19 outbreak has generated significant uncertainty about the future, especially for young adults. Health and economic threats, as well as more diffuse concerns about the consequences of COVID-19, can trigger feelings of anxiety, leading individuals to adopt uncertainty-reducing behaviours. We tested whether anxiety was associated with an increase in willingness to be exposed to the risk of COVID-19 infection (WiRE) using an online survey administered to 3,110 French individuals aged between 18 and 35 years old during the first pandemic wave and lockdown period (April 2020). Overall, 56.5% of the sample declared a positive WiRE. A one standard deviation increase in psychological state anxiety raised the WiRE by +3.9 pp (95% CI [+1.6, 6.2]). Unemployment was associated with a higher WiRE (+8.2 percentage points (pp); 95% CI [+0.9, 15.4]). One standard deviation increases in perceived hospitalisation risk and in income (+1160€) were associated with a -4.1 pp (95% CI [-6.2, 2.1]) decrease in the WiRE and +2.7 pp increase (95% CI [+1.1, 4.4]), respectively. Overall, our results suggest that both psychological anxiety and the prospect of economic losses can undermine young adults’ adherence to physical distancing recommendations. Public policies targeting young adults must consider both their economic situation and their mental health, and they must use uncertainty-reducing communication strategies.

The COVID-19 outbreak has generated significant uncertainty about the future, especially for young adults. Health and economic threats, as well as more diffuse concerns about the consequences of COVID-19, can trigger feelings of anxiety, leading individuals to adopt uncertainty-reducing behaviours. We tested whether anxiety was associated with an increase in willingness to be exposed to the risk of COVID-19 infection (WiRE) using an online survey administered to 3,110 French individuals aged between 18 and 35 years old during the lockdown period (April 2020). Overall, 56.5% of the sample declared a positive WiRE. Unemployment was associated with a higher WiRE (+8.2 percentage points (pp); 95% CI +0.9-15.4 pp). One standard deviation increases in income (+1160€) and psychological state anxiety raised the WiRE by +2.7 pp (95% CI: +1.1-4.4 pp) and +3.9 pp (95% CI: +1.6-6.2 pp), respectively. A one standard deviation increase in perceived hospitalisation risk was associated with a -4.1 pp (95% CI: -6.2-2.1 pp) decrease in the WiRE. Overall, our results suggest that both the prospect of economic losses and psychological anxiety can undermine young adults’adherence to physical distancing recommendations. Public policies targeting young adults must consider both their economic situation and their mental health, and they must use uncertaintyreducing communication strategies.

En dépit d’une des politiques les plus répressives d’Europe, les Français, et en particulier les mineurs, figurent parmi les plus gros consommateurs de cannabis de l’Union européenne. Le système de prohibition promu par la France depuis 50 ans est un échec : non seulement il est inapte à protéger les plus fragiles, notamment les jeunes mais, de surcroît, il pèse lourdement sur les dépenses publiques et profite aux organisations criminelles. Dans cette Note, nous explorons les réformes à entreprendre pour reprendre le contrôle de ce marché. L’analyse économique, combinée à l’étude des expériences étrangères récentes, montre que la légalisation du cannabis récréatif, strictement encadrée, permet à la fois de lutter contre le crime organisé, de restreindre l’accès au produit pour les plus jeunes et de développer un secteur économique, créateur d’emplois et de recettes fiscales.

Chaque jour, chaque heure, presque à chaque instant, les administrations publiques produisent et utilisent, pour les besoins de leur activité, de l’information : les caisses d’assurance maladie enregistrent les demandes de remboursement des soins reçus par les patients et les détails permettant de rémunérer les services de soins, les caisses de retraite ou d’allocations familiales conservent les informations pertinentes au calcul des droits des assurés sociaux et le détail des prestations versées, l’administration fiscale connaît pour chaque individu le détail de ses revenus, de sa composition familiale, de son logement et, pour les plus riches, de son patrimoine immobilier s’il est soumis à l’impôt.

In 2013, migrants accounted for 46% of newly diagnosed cases of HIV (human immunodeficiency virus) infection in France. These populations meet with specific obstacles leading to late diagnosis and access to medical care. Delayed access to care (ATC) for HIV-infected migrants reduces their life expectancy and quality of life. Given the reduction of infectivity under antiretroviral (ARV) treatment, delayed ATC for HIV-infected migrants may also hinder the control of the HIV epidemic. The objective of this study is to measure the public health and economic consequences of delayed ATC for migrants living with HIV in France. Using a healthcare payer perspective, our model compares the lifetime averted infections and costs of early vs. late ATC for migrants living with HIV in France. Early and late ATC are defined by an entry into care with a CD4 cell count of 350 and 100/mm3, respectively. Our results show that an early ATC is dominant, even in the worst-case scenario. In the most favorable scenario, early ATC generates an average net saving of €198,000 per patient, and prevents 0.542 secondary infection. In the worst-case scenario, early ATC generates an average net saving of €32,000 per patient, and prevents 0.299 secondary infection. These results are robust to various adverse changes in key parameters and to a definition of late ATC as an access to care at a CD4 level of 200/mm3. In addition to individual health benefits, improving ATC for migrants living with HIV proves efficient in terms of public health and economics. These results stress the benefit of ensuring early ATC for all individuals living with HIV in France.

Although end-of-life medical spending is often viewed as a major component of aggregate medical expenditure, accurate measures of this type of medical spending are scarce. We used detailed health care data for the period 2009–11 from Denmark, England, France, Germany, Japan, the Netherlands, Taiwan, the United States, and the Canadian province of Quebec to measure the composition and magnitude of medical spending in the three years before death. In all nine countries, medical spending at the end of life was high relative to spending at other ages. Spending during the last twelve months of life made up a modest share of aggregate spending, ranging from 8.5 percent in the United States to 11.2 percent in Taiwan, but spending in the last three calendar years of life reached 24.5 percent in Taiwan. This suggests that high aggregate medical spending is due not to last-ditch efforts to save lives but to spending on people with chronic conditions, which are associated with shorter life expectancies.

This paper explores the relationship between parental education and offspring body weight in France. Using two large datasets spanning the 1991–2010 period, we examine the existence of inequalities in maternal and paternal education and reported child body weight measures, as well as their evolution across childhood. Our empirical specification is flexible and allows this evolution to be non-monotonic. Significant inequalities are observed for both parents’ education – maternal (respectively paternal) high education is associated with a 7.20 (resp. 7.10) percentage points decrease in the probability that the child is reported to be overweight or obese, on average for children of all ages. The gradient with respect to parents’ education follows an inverted U-shape across childhood, meaning that the association between parental education and child body weight widens from birth to age 8, and narrows afterward. Specifically, maternal high education is correlated with a 5.30 percentage points decrease in the probability that the child is reported to be overweight or obese at age 2, but a 9.62 percentage points decrease at age 8, and a 1.25 percentage point decrease at age 17. The figures for paternal high education are respectively 5.87, 9.11, and 4.52. This pattern seems robust, since it is found in the two datasets, when alternative variables for parental education and reported child body weight are employed, and when controls for potential confounding factors are included. The findings for the trajectory of the income gradient corroborate those of the education gradient. The results may be explained by an equalization in actual body weight across socioeconomic groups during youth, or by changes in reporting styles of height and weight.

Le point de vue des économistes dans le débat sur la santé est réducteur. Mais tout réducteur qu’il soit, ce point de vue est aussi inévitable. En matière de santé comme ailleurs, nos sociétés ont à faire des choix que l’on qualifie habituellement d’économiques. La question de la bonne affectation des ressources entre les différents besoins de santé est donc « incontournable » ; arbitrer entre ces besoins est tout aussi difficile qu’inévitable. On peut s’interroger sur les raisons profondes de l’introduction et de l’essor d’une problématique de concurrence dans des domaines où elle n’était peut-être pas initialement présente. Nous ne sommes plus dans des sociétés de subsistance. Nous sommes dans des sociétés dans lesquelles le nombre de biens et de services qui sont fournis s’est considérablement multiplié. Cette situation exacerbe les difficultés de toute planification. L’intervention « centrale » pour décider de ce qui doit être est de plus en plus difficile : comment décider d’en haut ce qui est bon pour une personne déterminée, dans un monde où cette personne fait des arbitrages complexes entre les postes de sa consommation. Certes cette diversité des choix possibles est inégalement accessible selon le revenu. Mais nous vivons dans un monde de biens multipliés, dont beaucoup relèvent de ce que l’on appelait autrefois le superflu et non du nécessaire. La légitimité des mécanismes de type décentralisé s’accroît, et avec elle s’affaiblit le tabou sur la recherche de profit. Ceci vaut, même si c’est de façon atténuée, pour le secteur de la santé, non seulement parce qu’une partie des soins relève de ce que l’on nomme parfois le confort, mais parce que le progrès s’accompagne d’un accroissement des biens mis à la disposition, les traitements par exemple, et d’une indétermination croissante du registre du nécessaire. Trois textes ouvrent ce livre, le deuxième d’un cycle sur la santé : de Roger Guesnerie, L’inévitable regard économique ; de Pierre-Yves Geoffard, La santé et ses « marchés » ; de Julian Le Grand, La question du choix dans les systèmes de santé : illusion ou solution ?

Using a simple theoretical decision model and an original database, we were able to elicit the distribution of the utility value of having a child with Down syndrome for a large sample of French pregnant women (n = 28,341) between 2003 and 2007. We found that, on a scale where the value of a fetal death is 0 and the value of a healthy child is 1, the mean value for a child with Down syndrome is about −0.6. Assuming that the policymaker used the same decision model as the women, we infer from the French amniocentesis reimbursement regulation an implicit social value for a child with Down syndrome of −2.5. We conclude from our study that the policymaker is more likely to prevent the birth of children with Down syndrome than French women themselves.