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Arrêts maladie : comprendre les disparités départementales

  • Mohamed Ali Ben Halima

    ()

    (IRDES institut for research and information in health economics)

  • Thierry Debrand

    ()

    (IRDES institut for research and information in health economics)

  • Camille Regaert

    ()

    (IRDES institut for research and information in health economics)

L’objectif de cet article est de comprendre les disparités interdépartementales en termes d’arrêts maladie. Nous utilisons la base de données Hygie, construite à partir de la fusion de différents fihiers administratifs de salariés du secteur privé en France en 2005, qui permet de prendre en considération : les relations « employeurs/employés », l’impact des caractéristiques des entreprises sur la santé de leurs employés mais aussi les interactions entre la santé et le travail. Après avoir rappelé les différents déterminants, entre effet de composition et effet de contexte, des arrêts maladie et leur importance pour comprendre les différences géographiques, nous menons une analyse empirique en trois temps : une analyse descriptive pour mettre en évidence les différences interdépartementales, une analyse multivariée pour mettre en avant les facteurs explicatifs de la probabilité d’être en arrêt maladie et enfn une analyse des déterminants des différences entre les départements.Nos différentes modélisations explicitent une grande partie des disparités interdépartementales. Les effets de composition et les effets de contexte constituent approximativement la moitié de l’écart absolu et les deux tiers de l’erreur quadratique moyenne. Ce sont les variables décrivant l’offre médicale (densité d’omnipraticiens), les contrôles de l’Assurance maladie et l’âge d’entrée sur le marché du travail qui permettent le plus d’expliquer les disparités interdépartementales en matière d’arrêts maladie. Contrairement à d’autres variables de composition ou de contexte qui ont soit une inertie d’évolution temporelle certaine (par exemple : le taux de natalité, le secteur industriel,…), soit des variables pour lesquelles la politique publique de santé a peu d’effets (par exemple : politique de rémunération des entreprises, taux de chômage), le pourcentage d’arrêts de travail contrôlés et la densité d’omnipraticiens sont déjà des leviers importants des politiques de santé. Notre recherche montre qu’ils pourraient être utilisés comme des instruments d’une politique publique visant à la réduction des disparités géographiques.

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File URL: http://www.irdes.fr/EspaceRecherche/DocumentsDeTravail/DT39ArretsMaladieComprendreDisparitesDepartement.pdf
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Paper provided by IRDES institut for research and information in health economics in its series Working Papers with number DT39.

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Length: 30 pages
Date of creation: Feb 2011
Date of revision: Feb 2011
Handle: RePEc:irh:wpaper:dt39
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