[Prevalence of thirty long term disorders for French health insurance members in 1994]. / Prévalence des trente affections de longue durée pour les affiliés au Régime général de l'Assurance Maladie en 1994.

BACKGROUND: The French health insurance has carried out a survey to estimate the medical and social prevalence for the 30 long-lasting affections. This estimation was extended to the instantaneous morbidity prevalence for some of these diseases. METHODS: The random sampling represented 2% of the 3,337,795 patients who were affected by long-lasting affections (ALD 30). To codify the diagnoses, the "médecin conseil" proceeded by different ways: either by examining the patient, by consulting the practicing physician (69% of the patients), or by consulting the individual medical file. Morbidity prevalence estimates were limited to some diseases: those for which correcting coefficients were available or those for which the legislation on long-lasting affections were applied in patients not likely to come under "invalidity". RESULTS: In November 1994, among the patients who came under "ALD 30", 39% were affected with cardio-vascular diseases, about 15% were affected with psychiatric diseases, and a similar proportion presented cancer or diabetes. The estimation of the insulin-dependent diabetes morbidity prevalence was 4.1/1000, non insulin-dependent diabetes 18/1000, progressive rheumatoid polyarthritis 2.8/1000, Parkinson disease 2.0/1000, and multiple sclerosis 0.4/1000. This survey also estimated the prevalence of seven other affections. CONCLUSIONS: This survey provides morbidity prevalence rates estimated on the basis of a representative sample of a sub-population including 70% of the French population. Most results are close to those which have been already published, but some of them appear quite new.

[Chemoprevention of cancers, the point of view of health insurance]. / Chimioprévention des cancers, le point de vue de l'Assurance maladie.

Faced with scientific progress, social security must be concerned by ethics, especially by protection of personal integrity. Financial necessities lead to take into account the efficiency of public health interventions. But in front of potentially toxic drug, are we allowed to compare possible advantages with potentially serious risks for healthy women? For these reasons, social security takes a stand in favour of carefully controlled trials, focused on restricted target populations which are estimated at high risk of cancer. Research of side effects should be included in the follow of the patients and special caution should be taken to avoid premature spreading of this behaviour. About a financial contribution of social security, the National fund for health prevention, education and information (FNPEIS) could perhaps not support such a project, regarding to his experimental nature. CNAMTS-INSERM research contracts could be an alternative.

Researcher-driven versus policy-driven economic appraisal of health technologies: the case of France.

From the failure of early voluntarist attempts of the 1970's to introduce formal economic assessment in administrative decision-making for public health policies, to the recent introduction of new regulatory mechanisms to control the diffusion and use of health care technologies, the French experience deeply questions the mechanistic idea that reinforcement of cost-containment policies necessarily means successful opportunities for economic appraisal. The article presents various examples from the French health care system showing how ambiguities between the management goals of cost-containment and the promotion of economic appraisal can create barriers for acceptance of any form of economic analysis. But, it also draws some positive lessons about the ways to surpass the traditional opposition between 'researcher-driven' vs 'policy-driven' research in the field of health economic assessment through institutional innovations and methodological advances.

[Assessment of costs of health insurance, substitution therapy in chronic renal insufficiency]. / Evaluation du coût pour l'assurance maladie, des thérapeutiques substitutives de l'insuffisance rénale chronique (IRC).

The authors have studied the cost of the different treatments proposed in ESRD to patients attended by the same nephrologic team. For each patient they have isolated two consecutive periods of treatment, each six months apart. Treatment modifications noted between the two periods allowed the patient to be used as his own control. The results show that the costs are essentially composed of the dialysis sessions, hospitalisations and transport, and that their level and composition differ significantly between the different treatments. They derive a typology composed of three groups of patients, which differ in their treatment, age, duration of ESRD, complications, and total cost of treatment. They conclude that services should be organised in such a way that a range of different treatments can reasonably be provided, according to patient needs.