BARNAY Thomas

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This working paper aims to measure the specific effect of physical and psychosocial working conditions throughout the career on the self-reported physical and mental health of retirees as well as on their medication consumption. To do so, we mobilize data from the Health and Professional Itinerary Survey (Sip). We control for socio-economic, employment, career pathway and individual characteristics prior to entering the labour market. Our results highlight the negative role of past working conditions on the physical and mental health of retirees with a clear link between physical constraints and physical health on the one hand and psychosocial risks and mental health (including the use of medication) on the other. This result shows the long-term penalizing character of arduous working conditions on the health of retirees.

Our objective is to measure the causal impact of the self-assessed mental health status of 2006 (anxiety disorders and depressive episodes) on employment in 2010. We use data from the French Health and Professional Route survey (Sip, “Santé et itinéraire professionnel”). In order to control for endogeneity biases coming from the mental health indicator, we use bivariate probit models explaining simultaneously employment status and mental health. We control these results by observing the individual, employment, general health status, risky behaviours and professional characteristics. Our main findings are as follow: men suffering from depression or anxiety are up to 13 percentage points less likely to remain in their job. We do not find such a relationship in women, after controlling for general health status. The robustness checks conducted on age and specifically those taking into account for the 2007-2010 period confirm these results.Our objective is to measure the causal impact of the self-assessed mental health status of 2006 (anxiety disorders and depressive episodes) on employment in 2010. We use data from the French Health and Professional Route survey (Sip, “Santé et itinéraire professionnel”). In order to control for endogeneity biases coming from the mental health indicator, we use bivariate probit models explaining simultaneously employment status and mental health. We control these results by observing the individual, employment, general health status, risky behaviours and professional characteristics. Our main findings are as follow: men suffering from depression or anxiety are up to 13 percentage points less likely to remain in their job. We do not find such a relationship in women, after controlling for general health status. The robustness checks conducted on age and specifically those taking into account for the 2007-2010 period confirm these results.

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The objective of this paper is to evaluate the short- and medium-term impact of road accidents on the career paths of French electricity board employees (EDF-GDF), with special emphasis on those coming to the end of their professional careers, based on the Gazel cohort for the period 2002–2014. This study analyzes the adaptation strategies developed by firms and victims following such an exogenous shock. It sheds light on the ability of stakeholders to adjust, in a context marked by a political desire to reform retirement, in particular for special arrangements such as those of EDF-GDF. The Gazel database makes it possible to characterize the different types of road accidents in order to analyze their impacts on the changes in the careers paths of professionals coming to the end of their careers. The econometric strategy is based on the difference-in-differences method with propensity score matching. In total, 4,066 people were victims of road accidents during the study period. On average, victims were older, from lower socioeconomic groups, and were more likely to be male. The analysis shows that victims who suffer serious physical or material consequences exit the labor market earlier, likely due to a reclassification mechanism that offers the right to early retirement. Victims of road accidents whose health is not impacted face fewer changes to their career paths.

The 4th cover page states: "Although the arduousness of work contributes to the deterioration of health, studies also show that employment preserves it by promoting access to healthcare. The relationship between the state of health of individuals and the labour market has been the subject of much debate and legislation. The current provisions, based on a logic of compensation and reparation, do not take sufficient account of the complexity of these interactions, which are further increased by the ageing of the population and the lengthening and precariousness of professional trajectories. Faced with health risks, we need more prevention and more secure career paths".

This report studies the short- and medium-term effects of the occurrence of cancer on employment and activity. It uses the Hygie database, produced by Irdes from administrative data of the National Health Insurance Fund and the National Old Age Insurance Fund. Hygie makes it possible to reconstruct the individual's career and health events. A first part exploits the retrospective dimension linked to the career and confirms the penalizing effect of cancer on activity and the increase in sick leave. The results of a double-difference model with exact matching show the persistence of the effects of the disease on the distance from the labour market, with the probability of being employed at least one quarter in the year decreasing up to a five-year horizon. We also measure the effect of the twelve most prevalent cancers in the Hygie database and of chronic diseases with a potential impact on the labour market. The largest effects are for lung and bronchial cancer, schizophrenia and HIV. Chronic diseases other than cancer have much smaller effects, probably because their long-term treatment improves quality of life. A second part exploits the panel dimension of the sample to study occupational transitions following a cancer diagnosis. It shows that the affected population encounters great difficulties in remaining in employment, or returning to it. These difficulties are accentuated for employees who are new to the job market or who have had an unstable career, or one marked by significant sick leave. In addition, the after-effects of care lead to a more frequent transition to unemployment and inactivity to the detriment of employment. Developing professional support methods for people whose careers have been more uneven, and whose socio-professional status is less protective, would therefore be one way of improving their living conditions.

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The aim of this article is to measure the specific effect of physical and psychosocial working conditions encountered during the entire working career on the self-reported physical and mental health and drug consumption of retirees. To do this, we use data from the Health and Professional Itinerary Survey (Sip). We control for socio-economic, career pathway and individual characteristics prior to entering the labour market, but also for health status in childhood and adulthood. Our results highlight the negative role of past working conditions on the physical and mental health of retirees with a clear link between physical constraints and physical health on the one hand and psychosocial risks and mental health (including the use of medication) on the other. This result shows the long-term penalizing character of arduous working conditions on the health of retirees.

In France, the French Disabled Workers Act set up a legal quota of disabled workers in more than 20 employees companies. In order to encourage employers to better promote the employment of disabled people, this law decreed financial penalties for noncompliance. The aim of this paper is to evaluate the impact of this law on the employment of disabled people. We use a triple difference approach combined with dynamic exact matching and weighting methods in order to disentangle the pure effect of the legislation by controlling for both observable and unobservable correlated heterogeneities.

In France, cardiovascular disease (CVD) is the leading cause of death in women. The role of the occupational environment in the development of these diseases is poorly documented. The objective of this study was to evaluate the effect of exposure to physical work constraints on the declaration of CVD in women. Material and method - Using data from the Health and Professional Itinerary Survey (SIP), which provides detailed information on individuals' working conditions, health status, and career, we used indicators relating to night work, repetitiveness, physical load, and exposure to toxic substances, reported in 2006. We then used a combined indicator accounting for exposures over the entire career. Binomial logit modelling was performed on 2,780 women and 2,633 men employed in 2006, in order to analyse the prevalence of CVD declared in 2010 and occurring after 2006. To control for confounding factors, individual characteristics in 2006 (age, occupation and socio-professional category, marital status, working hours, smoking and alcohol consumption, body mass index), past characteristics (level of education and health), and employment status in 2010 were controlled. Results- Among women, an association between exposure to harmful products (OR=2.36) and to at least two physical constraints (OR=1.98) and the declaration of CVD was demonstrated, as well as an association between exposure to toxic products and arterial hypertension (AH) (OR=1.84). The combined career indicator was significantly associated with higher reporting of CVD (OR=1.54) and hypertension (OR=1.53). Except for demanding work (OR=1.35), we did not find a significant response to physical constraints in men. Conclusion- This result calls for cardiovascular risk prevention that specifically takes women into account and integrates the actors of the professional environment.

While theoretical models on long-term care decisions assume that the health production function of dependent elderly depends positively on the care received, it has not received much attention in the empirical literature. We estimate the effects of both informal and formal home care on the mental health of elderly individuals in France needing help with daily activities. We adjust for the endogeneity of care with instrumental variables, using characteristics of adult children and geographical disparities in access to public long-term care coverage. The results show that informal care reduces the risk of depression of dependent elderly and that formal care increases their general mental health.

This thesis focuses on the question of variability in cancer management practices and on the study of the determinants of social and spatial inequalities in access to care, with a particular focus on cancer patients. In recent years, public authorities have noted strong variability in the rates of recourse to certain types of treatment. The first chapter of this thesis asks the question of the determinants of differences in the use of prostatectomy as a treatment for prostate cancer. The results show a strong positive influence of variables relating to the supply of care, both at the level of the department and the region, and the fight against social inequalities in health is also carried out thanks to mechanisms such as the ALD. The second chapter looks at the determinants of the use of general practitioners and specialists, differentiating between visits to the latter that are related to ALD pathology and those that are not. For visits to general practitioners, the results show that a lower socio-economic status seems to be associated with a higher use of care. Finally, since 2004, an organized breast cancer screening program has been in place for all women aged 50 to 74. The objective of the last chapter is to examine the potential influence of the density of general practitioners and specialists on the rates of recourse to this screening over the period 2005-2012. It appears that a higher density of general practitioners is significantly associated with a higher utilization rate. Conversely, an increase in the density of specialists tends to have a negative impact. The estimates also highlight a spatial effect . medical densities in neighboring departments also have an effect on the use of organized screening.

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In France, the French Disabled Workers Act set up a legal quota of disabled workers in more than 20 employees companies. In order to encourage employers to better promote the employment of disabled people, this law decreed financial penalties for noncompliance. The aim of this paper is to evaluate the impact of this law on the employment of disabled people. We use a triple difference approach combined with dynamic exact matching and weighting methods in order to disentangle the pure effect of the legislation by controlling for both observable and unobservable correlated heterogeneities.

The generalization of third-party payment was adopted by the National Assembly in April 2015 as part of the new Health Law. By 2017, it will allow all patients to avoid having to pay in advance to the doctor and then wait for reimbursements from the AMO (Compulsory Health Insurance) and the Ocam (Supplementary Health Insurance Organizations), if necessary. The questioning of this French specificity is fuelling lively debates between the different actors of the health system: doctors, patients and insurers (AMO and Ocam). Several questions, more or less well-founded, run through these debates and will structure our discussion: -Is the generalization of third-party payment fair? -Does it make care free? -Is the generalization of third-party payment inflationary? -Is it the "programmed death" of liberal medicine? -Does it give full powers to the compulsory health insurance? Moreover, in the background, at a time when the injunction of prevention is omnipresent in the law on the modernization of our health system, more pressing questions for the health system are posed with acuity: its efficiency, equity of access to primary care, the development of information systems, the coordination of health care actors and even the social acceptability of the current system.

In France, the number of dependent elderly should d ouble by 2060. It is thus important to address the well-being of this growing share of the population. This work aims at estimating the effects of informal care and formal care on the mental health of dependent elderly. Furthermore, we allow the effect of care to vary de pending on the level of dependence, the gender of the dependent elderly and the relationship between the elderly and the primary informal caregiver. Many theoretical models include a production function of health which has two inputs, formal care and informal care but t his function has not been the subject of many empirical studies. In order to estimate the health production function, we use the French Disability and Health Survey (2008). Using a sample of 4,067 dependent elderly, three equations are jointly estimated by the maximum-likelihood method: mental health, informal care and formal care. Correlated residuals partially take into account the relationship between formal and informal cares and the reverse causality of mental health on care received. We use two mental health indicators: depression and the Mental-Health Inventory (MHI-5). The results show a positive effect of informal care on mental health, for slightly dependent elderly, for individuals receiving care from friends or neighbors and for men receiving care from a daughter or from siblings. Formal care decreases the risk of depression and improves the MHI-5 of elderly dependent people, this last effect being higher for women.

Among private sector employees who were off work for more than one month during the year due to illness, 15% of women and 11% of men were unemployed or inactive the following year (compared with 7% and 4% respectively of employees who had not been off sick). This finding is not only attributable to the lower quality of the jobs held by people in poor health. It shows that sick leave has a penalizing effect on the career paths of both men and women. This effect is all the more marked the longer the period spent on sick leave. Maternity leave is more often followed by a year's inactivity than is long-term sick leave, but the majority of women who remain in employment after childbirth return to work without interruption. When they return to work, the formerly unemployed and the economically inactive take fewer sick leave days than other employed workers, indicating that they anticipate the risks of deteriorating career paths associated with these work stoppages.

Tunisia is experiencing a significant increase in health care spending and in the life expectancy of Tunisians. But these results go hand in hand with inequalities in access to care, motivating a health insurance reform implemented in 2007. The main changes aim at improving coverage for chronic diseases and generalizing insurance for private health care. This applied microeconometrics thesis examines the impact of the reform on access to care and out-of-pocket expenses. The evaluations are based on surveys of several thousand individuals in 2005 and 2010. The motivations for the reform are presented, before analyzing the choice of insurance and its influence on the use of public or private care providers in 2010, after the reform. An evaluation of the reform was analyzed using the difference-in-differences approach. Overall, the results show that this reform seems to have achieved several of its objectives: improved access to care for members of the National Social Security Fund (CNSS), better access to private care, and a reduction in out-of-pocket expenses and catastrophic expenses for people with chronic diseases.

The reduction of inequalities in the face of disease is one of the major expectations of the third Cancer Plan 2014-2019, which recommends "reducing the impact of cancer on personal life" in order to avoid the "double penalty" (disease and exclusion from the labor market). In this context, we evaluate the impact of one to five years of a first registration as a long-term disease (ALD) characterizing cancer on the employment status and duration spent in employment, illness and unemployment of private sector employees. We use the Hygie administrative database, which records the professional career and illness episodes of a sample of employees affiliated to the General Social Security System. The evaluation of the impact of the occurrence of cancer is based on a double difference method with exact matching to compare sick employees to employees without any ALD. The first year after diagnosis corresponds to the time of treatment characterized by an increase in the number of quarters of sick leave of 1.7 for women and 1.2 for men. Age also plays a role in illness-related absences. In addition, the employability of workers with cancer decreases over time. The proportion of women and men employed for at least one quarter drops by 8 and 7 percentage points respectively in the year following the onset of cancer and up to 13 percentage points five years later. This distance to employment increases when the sick employees are older. The effect of the disease at five years is 15 and 19 percentage points respectively for men over 51 and for women over 48. These gender and age differences may reflect differences in the location and severity of the cancers, on the one hand, and in the after-effects of the cancers and the difficulties of re-entering the labour market, which are greater with advancing age, on the other.

Approximately 12% of women and 6% of men aged 30 to 55, who were working in 2006, declared that they suffered from at least one mental disorder (generalized anxiety disorder or characterized depressive episode). Among these people, more than 20% mention an activity limitation, about 45% say they suffer from a chronic illness and nearly half consider themselves to be in poor health. Job retention is less frequent in the population reporting mental disorders. In fact, 86% of women and 82% of men with mental disorders remained in employment in 2010, compared with 92% and 93% respectively of people without mental disorders. For men, with similar socio-demographic and employment characteristics, suffering from a generalized anxiety disorder in 2006 reduces the chances of keeping a job in 2010. On the other hand, for women, mental health does not affect their professional trajectory, all other things being equal. It is the declared activity limitations that most increase the risk of not keeping one's job.

Health inequalities are marked in France according to social group. In 2006, among the population aged 30 to 49 years, working in 2006 and 2010, executives and intermediate professions were respectively 90% and 87% to consider themselves in good or very good health, against 81% of employees and 79% of workers. Starting from a high level of perceived health, executives are less likely to see their health improve between 2006 and 2010. In fact, 6% of them report such an improvement during this period, compared to 8% of blue-collar workers. However, the evolution of the health of managers is globally more favourable than that of workers, since fewer of them report a deterioration of their health between 2006 and 2010 (8% versus 15%). For comparable general health status and individual characteristics in 2006, managers and intermediate professions are less likely than workers to experience a deterioration in their perceived health four years later.

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Economists have traditionally been very cautious when studying the interaction between employment and health because of the two-way causal relationship between these two variables: health status influences the probability of being employed and, at the same time, working affects the health status. Because these two variables are determined simultaneously,researchers control endogeneity skews (e.g., reverse causality, omitted variables) when conducting empirical analysis. With these cave at sin mind, the literature finds that a favourable work environment and high job security lead to better health conditions. Being employed with appropriate working conditions plays a protective role on physical health andpsychiatric disorders. By contrast, non-employment and retirement are generally worse for mental health than employment,and over employment has a negative effect on health. These findings stress the importance of employment and of a dequateworking conditions for the health of workers. In this context, it is a concern that a significant proportion of European workers(29%) would like to work fewer hours because unwanted long hours are likely to signal a poor level of job satisfaction andinadequate working conditions, with detrimental effects on health. Thus, in Europe, labour-market policy has increasingly paid attention to jobs ustainability and job satisfaction. The literature clearly invites employers to take better account of the worker preferences when setting the number of hours worked. Overall, a specific “flexicurity” (combination of high employment protection, job satisfaction and activelabour-market policies) is likely to have a positiveeffect on health.

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The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae, and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand, or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material. The healthy ageing assumptions may lead to substantial changes in paths of aggregate health care expenditure, notably catastrophic expenditure of people at the end of the life. But clear assessments of involved amounts are not available when we specifically consider ambulatory care (as drug expenditure) generally offered to chronically-ill people. We estimate the effects of epidemiological and life expectancy changes on French health expenditure until 2029 by applying a Markovian micro-simulation model from a nationally representative database. The originality of these simulations holds in using an aggregate indicator of morbidity–mortality, capturing vital risk and making it possible to adapt the quantification of life expectancies by taking into account the presence of severe chronic pathologies. We forecast future national drugs expenditure, under different epidemiological scenarios of chronic morbidity: trend scenario, healthy ageing scenario and medical progress scenario. For the population aged 25+, results predict an increase in reimbursable drug expenditure of between 1.1% and 1.8% (annual growth rate), attributable solely to the ageing population and changes in health status.