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Améliorer la prise en charge sanitaire et sociale des personnes âgées : impact des plans personnalisés de santé sur les parcours de soins

Author

Listed:
  • Anne Penneau

    (IRDES Institut de recherche et documentation en économie de la santé)

  • Damien Bricard

    (IRDES Institut de recherche et documentation en économie de la santé)

  • Zeynep Or

    (IRDES Institut de recherche et documentation en économie de la santé)

Abstract
Assurer une prise en charge sanitaire et sociale adaptée aux besoins des personnes âgées est un enjeu majeur des politiques publiques. Dans le cadre des expérimentations Parcours santé des aînés (Paerpa), lancées en 2014 pour améliorer la prise en charge des personnes âgées en « risque de perte d’autonomie », un outil de coordination, le Plan personnalisé de santé (PPS), a été proposé. Le PPS est un outil innovant qui a pour objectif d’améliorer la coordination et la continuité des prises en charge sanitaires et sociales, et ainsi de prévenir la perte d’autonomie, d'éviter le recours inapproprié à l’hospitalisation et la polymédication. Notre étude vise à évaluer l’impact de la réalisation d’un PPS sur les parcours de soins en observant l’évolution de la consommation de soins et de la qualité de prise en charge des personnes âgées qui en bénéficient. L’évaluation est réalisée à partir des données de consommation inter-régime de l’Assurance maladie appariées aux bases de données hospitalières de 2014 à 2017. Nous développons une analyse en doubles différences après appariement afin de mesurer la différence d’évolution entre les traités et les témoins, avant et après la réalisation du PPS. Afin de s’affranchir du biais de sélection pouvant persister à cause du manque de données sociales et d’état de santé dans les bases de données dont nous disposons, nous introduisons dans l’analyse un instrument qui exploite les différences de diffusion du PPS auprès des médecins généralistes entre les communes des territoires Paerpa. Nos résultats montrent que les personnes âgées qui ont bénéficié du PPS ont des besoins complexes, nécessitant une prise en charge sanitaire et médico-sociale. On observe un impact direct du PPS sur les dépenses d’infirmières à domicile qui augmentent significativement dans la première année suivant le PPS, sans se traduire par une augmentation des dépenses globales en ville, puisqu'il s'accompagne d'une réduction des dépenses de soins de généralistes et de médicaments. En revanche, on ne constate aucun effet significatif du PPS sur les hospitalisations évitables, la polymédication et le recours aux urgences. Au regard de nos résultats et des remontées des informations des territoires pilotes, le PPS semble être un outil mobilisé par les professionnels de santé de premier recours pour enclencher une prise en charge médico-sociale et sociale au domicile de la personne. Mais pour assurer la qualité et la continuité de la prise en charge globale, il serait important de créer des passerelles plus formalisées avec les médecins spécialistes et les acteurs hospitaliers.

Suggested Citation

  • Anne Penneau & Damien Bricard & Zeynep Or, 2019. "Améliorer la prise en charge sanitaire et sociale des personnes âgées : impact des plans personnalisés de santé sur les parcours de soins," Working Papers DT81, IRDES institut for research and information in health economics, revised Jul 2019.
    • Handle: RePEc:irh:wpaper:dt81
    as

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    References listed on IDEAS

    as
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    Cited by:

    1. Or, Zeynep & Gandré, Coralie & Durand Zaleski, Isabelle & Steffen, Monika, 2022. "France's response to the Covid-19 pandemic: between a rock and a hard place," Health Economics, Policy and Law, Cambridge University Press, vol. 17(1), pages 14-26, January.

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    More about this item

    Keywords

    Coordination des soins; évaluation de politiques publiques; Personnes âgées;
    All these keywords.

    JEL classification:

    • C22 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Time-Series Models; Dynamic Quantile Regressions; Dynamic Treatment Effect Models; Diffusion Processes
    • C26 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Instrumental Variables (IV) Estimation
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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