Abstract
Background Description of the prevalence of diseases and resources mobilized for the management of each disease is essential to identify public health priorities. We described the prevalences of 58 health conditions and all reimbursed healthcare expenditure by health condition in France between 2012 and 2017.
Methods and Findings All national health insurance general scheme beneficiaries (87% of the French population) with at least one reimbursed healthcare expenditure were included from the French national health database. We identified health conditions (diseases, episodes of care, chronic treatments) by algorithms using ICD-10 codes for long-term diseases or hospitalisations, medications or medical procedures. We reported crude and age and sex-standardized annual prevalences between 2012 and 2017, and total and mean (per patient) reimbursed expenditure attributed to each condition without double counting, and according to the type of expenditure.
In 2017, in a population of 57.6 million people (54% of women, median age: 40 years), the most prevalent diseases were diabetes (standardized prevalence: 5.8%), chronic respiratory diseases (5.5%) and chronic coronary heart disease (2.9%). Diseases concentrating the highest expenditures were active cancers (10% of total expenditure of €140.1 billion), mental illness (10%; neurotic and mood disorders: 4%; psychotic disorders: 3%), and chronic cardiovascular diseases (8%). Between 2012 and 2017, the most marked increase in total expenditure concerned liver and pancreatic diseases (+9.3%), related to the increased drug expenditure in 2014. Conversely, the increase in the number of patients (and the prevalence) explained the majority of the increase of total expenditures for cardiovascular disease, diabetes and mental illness.
Conclusions These results showed a regular increase of the prevalence and expenditure of certain chronic diseases, probably related to ageing of the population, and increased expenditures related to major therapeutic innovations. The Diseases and Healthcare Expenditure Mapping therefore enlightens decision-makers in charge of public health and health accounts.
Competing Interest Statement
The authors have declared no competing interest.
Funding Statement
No external funding was received for this work.
Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
Access to data is subject to prior training and authorisation and needs approval by the independent French data protection authority ('Commission Nationale Informatique et Libertes'). Our public institution has permanent access to SNDS data in application of the provisions of articles R. 1461-12 et seq. of the French Public Health Code, therefore ethical board approval was not required.
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Data Availability
Data cannot be shared publicly because it is forbidden by law (sensitive individual data). Data are available from the Health Data Hub (contact via hdh@health-datahub. fr) for researchers who meet the criteria for access to confidential data.