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

François Birault, Stéphanie Mignot, Nicole Caunes, Philippe Boutin, Emilie Bouquet, Marie-Christine Pérault-Pochat and Bérangère Thirioux
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François Birault: Département de Médecine Générale, Faculté de Médecine et de Pharmacie, Université de Poitiers, 86000 Poitiers, France
Stéphanie Mignot: Département de Médecine Générale, Faculté de Médecine et de Pharmacie, Université de Poitiers, 86000 Poitiers, France
Nicole Caunes: Département de Médecine Générale, Faculté de Médecine et de Pharmacie, Université de Poitiers, 86000 Poitiers, France
Philippe Boutin: Département de Médecine Générale, Faculté de Médecine et de Pharmacie, Université de Poitiers, 86000 Poitiers, France
Emilie Bouquet: Service de Pharmacologie Clinique et Vigilances, Université, CHU de Poitiers, 86021 Poitiers, France
Marie-Christine Pérault-Pochat: Service de Pharmacologie Clinique et Vigilances, Université, CHU de Poitiers, 86021 Poitiers, France
Bérangère Thirioux: Unité de Recherche Clinique Intersectionnelle en Psychiatrie à Vocation Régionale Pierre Deniker, Centre Hospitalier Henri Laborit, 86021 Poitiers, France

IJERPH, 2020, vol. 17, issue 9, 1-12

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.

Keywords: universal health cover; precarious populations; reimbursed drugs prescriptions; general practice (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
References: View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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