The Characteristics of Care Provided to Population(s) in Precarious Situations in 2015. A Preliminary Study on the Universal Health Cover in France
Open Access
- 8 May 2020
- journal article
- research article
- Published by MDPI AG in International Journal of Environmental Research and Public Health
- Vol. 17 (9), 3305
- https://doi.org/10.3390/ijerph17093305
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.This publication has 24 references indexed in Scilit:
- Empathy Is a Protective Factor of Burnout in Physicians: New Neuro-Phenomenological Hypotheses Regarding Empathy and Sympathy in Care RelationshipFrontiers in Psychology, 2016
- Les inégalités de recours aux soins : bilan et évolutionRevue D'epidemiologie Et de Sante Publique, 2013
- Socioeconomic status as a risk factor for late presentation of glaucoma in CanadaCanadian Journal of Ophthalmology, 2013
- Positivisme et dépendance : les usages socioculturels du médicament chez les médecins généralistes françaisSciences sociales et santé, 2012
- Surmortalité et hospitalisations plus fréquentes des bénéficiaires de la couverture médicale universelle complémentaire en 2009La Presse Médicale, 2011
- Socioeconomic and Racial/Ethnic Disparities in the Incidence of Bacteremic Pneumonia Among US AdultsAmerican Journal of Public Health, 2010
- Traitement du VIH/sida en Afrique: la gratuité pour limiter les coûtsGlobal Health Promotion, 2010
- The Role of Poverty in Antimicrobial ResistanceThe Journal of the American Board of Family Medicine, 2007
- Prescription Cost SharingPharmacoEconomics, 1992
- Payment Restrictions for Prescription Drugs under MedicaidThe New England Journal of Medicine, 1987