The Characteristics of Care Provided to Population(s) in Precarious Situations in 2015. A Preliminary Study on the Universal Health Cover in France

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’ 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–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–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.

High and daily exposure to precariousness negatively impacts the prescriptions of general practitioners to precarious populations: an observational pharmaco-epidemiological study investigating inequalities in access to health care in France

“…The remaining 9 molecules were under-reimbursed in this same population. In line with our previous study [5], there was more drugs that were under-(n = 7) than over-reimbursed (n = 2).…”

“…We investigated whether high and daily exposure of GPs to precariousness increases the inequality of prescriptions between non-precarious and precarious populations. Using the same pharmacoepidemiological approach as in our previous national study [5], we focused our analyses on four French regional populations with respectively low (BR, CR) and high (OSR, OCR) precariousness prevalence. We assumed that there are more inequalities in prescriptions of GPs who are more highly and daily exposed to precariousness (OSR, OCR) compared to GPs who are less exposed to precariousness (BR, CR).…”

“…This is not the case. Indeed, in a previous pharmaco-epidemiological study, we have recently shown that six molecules (metformin, atorvastatin, rosuvastatin, tamsulosine, paracetamol, and timolol) are signi cantly less reimbursed and, thus, less prescribed, in precarious populations [5]. These differences were not explained by a speci c epidemiology.…”

“…We used the De ned Daily Dose (DDD) as a criterion of principal evaluation. That is, we hypothesized that differences in reimbursed drugs prescriptions are re ected in DDD modulations for given molecules between populations (same as in Birault et al 2020 [5]).…”

“…These are also supposed to decrease inequalities in access to health care, permitting precarious people to bene t from free health expenditure. The French Health System is complex (for more details, see Birault et al [5]). Basically, people with a monthly income below EUR 720 for a single person and EUR 1080 for a couple living in urban areas are considered "precarious".…”