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Published byPierce Dean Modified over 9 years ago
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Comments from France on the 2014 Commonwealth Fund Survey on Older Adults Pr Isabelle Durand-Zaleski
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Key findings High population coverage by statutory health insurance Lowest cost related access problems Chronic conditions are covered 100% by the SHI Access: Best same-day access to care Low ER visits Low waiting times Coordination Patients do not perceive the lack of coordination But report gaps between hospital and out of hospital care
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The paradoxes Very good patient doctor relationship but no lifestyle or end-of-life discussion Statutory health insurance funding (health care) disconnected from social care funding: results in Excellent access to physicians and health care Poor coordination and limited task shifting between health and social care
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Access to care 8/10 adults over 65 report a chronic condition Low number of physician encounters and prescription drugs In France year 80 is the year of living dangerously, ie, cutoff age for: ER admissions Home services Health and social care expenditures are doubled between 80 and 90 years
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Yearly healthcare expenditures by person by age group Sources : 2008 et PMSI SSR CNSA ; DREES, HCAAM. Medico- social care nursing hospital Out of hospital care
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ER admission, by age source HCAAM
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In reality, access to care is not so good: bars represent the amount of out-of-pocket expenditures for health Sources : CNAMTS, EGB 2008 ; PMSI MCO 2008, PMSI HAD 2008, RIM P 2008 et PMSI SSR 2008. Calculations by : secrétariat général du HCAAM Out-of-pocket expenditures by person Average = 470€ Out of hospital hospital
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Patient engagement and end-of-life planning Satisfaction with patient-doctor relationship: French patients can choose their physician Opponents of the health reform law currently discussed at the Parliament suggest that freedom of choice might be curtailed End of life: Political and contentious All religious leaders have opposed the end-of-life law
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Coordination Despite patients’ perceptions, the lack of coordination for older adults is repeatedly pointed to as a weakness in France The PAERPA experiments (care pathways for persons at risk of loss of autonomy) are designed at the local level to specifically address the needs of fragile elderly
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Conclusion Perception from patients about access and care coordination is reassuring Reality might be less bright, particularly for patients over age 80
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