{"id":43804,"date":"2026-09-29T17:15:51","date_gmt":"2026-09-29T21:15:51","guid":{"rendered":"https:\/\/intosaijournal.org\/journal-entry\/data-science-to-measure-out-of-pocket-costs-for-women-with-breast-cancer\/"},"modified":"2026-10-01T18:07:55","modified_gmt":"2026-10-01T22:07:55","slug":"data-science-to-measure-out-of-pocket-costs-for-women-with-breast-cancer","status":"publish","type":"journal-entry","link":"https:\/\/www.intosaijournal.org\/fr\/journal-entry\/data-science-to-measure-out-of-pocket-costs-for-women-with-breast-cancer\/","title":{"rendered":"La data science pour mesurer le reste \u00e0 charge des femmes atteintes d’un cancer du sein"},"content":{"rendered":"\n

Par Appoline Chariot, data scientist \u00e0 la Cour des comptes<\/p>\n\n\n\n

Que paient r\u00e9ellement les femmes atteintes d’un cancer du sein pour se soigner ? R\u00e9pondre de mani\u00e8re rigoureuse, \u00e0 partir des donn\u00e9es disponibles, constitue un v\u00e9ritable d\u00e9fi m\u00e9thodologique.<\/p>\n\n\n\n

Dans le cadre d\u2019une enqu\u00eate de la Cour des comptes de France consacr\u00e9e \u00e0 la pr\u00e9vention et \u00e0 la prise en charge du cancer du sein, l\u2019objectif a \u00e9t\u00e9 de mieux comprendre les cons\u00e9quences financi\u00e8res de la maladie pour les patientes. <\/p>\n\n\n\n

Pour r\u00e9pondre \u00e0 cette question, l\u2019\u00e9quipe d\u2019audit a sollicit\u00e9 le d\u00e9partement \u00ab Analyse et sciences des donn\u00e9es \u00bb (DASD) de la Cour des comptes, qui a mobilis\u00e9 les donn\u00e9es du Syst\u00e8me national des donn\u00e9es de sant\u00e9 (SNDS). Ces donn\u00e9es ont permis de construire une mesure du reste \u00e0 charge apr\u00e8s assurance maladie obligatoire des femmes atteintes d\u2019un cancer du sein.<\/p>\n\n\n\n

\u00c9laborer un indicateur mesurable \u00e0 partir des donn\u00e9es m\u00e9dico-administratives<\/strong><\/h2>\n\n\n\n

Pour mesurer le reste \u00e0 charge, il faut d\u2019abord pr\u00e9ciser cette notion qui n\u2019a pas de d\u00e9finition unique et qui n\u2019existe pas directement dans les bases m\u00e9dico-administratives.<\/p>\n\n\n\n

Les donn\u00e9es du SNDS permettent d\u2019observer les soins consomm\u00e9s et les remboursements effectu\u00e9s par l\u2019assurance maladie obligatoire pour chaque patiente. Mais elles ne permettent pas de reconstituer le co\u00fbt final r\u00e9ellement support\u00e9, car les remboursements des compl\u00e9mentaires sant\u00e9 ainsi que les d\u00e9penses li\u00e9es aux soins non rembours\u00e9s n\u2019y figurent pas.<\/p>\n\n\n\n

L\u2019analyse s\u2019est donc concentr\u00e9e sur un reste \u00e0 charge apr\u00e8s remboursement de l\u2019assurance maladie obligatoire et avant remboursement \u00e9ventuel par l\u2019assurance maladie compl\u00e9mentaire, le reste \u00e0 charge r\u00e9el d\u00e9pendant de la couverture compl\u00e9mentaire.<\/p>\n\n\n\n

Le r\u00f4le du data scientist ne se limite pas \u00e0 la mise en \u0153uvre de m\u00e9thodes quantitatives : il implique une compr\u00e9hension fine du syst\u00e8me de sant\u00e9, en l\u2019occurrence, et des enjeux de politique publique, condition indispensable pour identifier les donn\u00e9es pertinentes, en interpr\u00e9ter les limites et construire des indicateurs robustes. Cette expertise lui permet d\u2019op\u00e9rer la traduction entre les questions de l\u2019\u00e9valuation de politique publique et leur formalisation analytique.<\/p>\n\n\n\n

Reconstruire le reste \u00e0 charge \u00e0 partir de plusieurs milliards de donn\u00e9es<\/strong><\/h2>\n\n\n\n

L\u2019analyse a port\u00e9 sur une cohorte de pr\u00e8s de 29 000 femmes diagnostiqu\u00e9es d\u2019un cancer du sein en 2022. Pour chacune d\u2019entre elles, l\u2019ensemble des d\u00e9penses observ\u00e9es au cours des deux ann\u00e9es suivant le diagnostic a \u00e9t\u00e9 \u00e9tudi\u00e9 : hospitalisations, consultations m\u00e9dicales, actes techniques, m\u00e9dicaments, dispositifs m\u00e9dicaux ou encore transports sanitaires.<\/p>\n\n\n\n

Le reste \u00e0 charge apr\u00e8s assurance maladie obligatoire regroupe des montants de nature diff\u00e9rente. Une premi\u00e8re partie correspond \u00e0 la part dite \u00ab opposable \u00bb, la diff\u00e9rence entre le tarif de r\u00e9f\u00e9rence et le remboursement de l\u2019assurance maladie obligatoire. Une seconde partie r\u00e9sulte de la libert\u00e9 tarifaire associ\u00e9e \u00e0 certaines prestations de soins, notamment sous la forme de d\u00e9passements d\u2019honoraires des professionnels de sant\u00e9.<\/p>\n\n\n\n

Afin de reconstituer le reste \u00e0 charge, le DASD de la Cour des comptes a adapt\u00e9 un algorithme d\u00e9velopp\u00e9 par le service statistique du minist\u00e8re de la sant\u00e9, ce qui a n\u00e9cessit\u00e9 un travail m\u00e9thodologique important et une d\u00e9clinaison sp\u00e9cifique au cancer du sein. Cet outil permet de reconstituer le montant de la d\u00e9pense, le remboursement par l\u2019assurance maladie obligatoire et le reste \u00e0 charge r\u00e9siduel.<\/p>\n\n\n\n

Objectiver le r\u00f4le des d\u00e9passements d\u2019honoraires<\/strong><\/h2>\n\n\n\n

Les r\u00e9sultats obtenus ont permis d\u2019objectiver des ph\u00e9nom\u00e8nes souvent \u00e9voqu\u00e9s mais rarement quantifi\u00e9s : au cours des deux ann\u00e9es suivant leur diagnostic, les femmes atteintes d\u2019un cancer du sein supportent en moyenne un reste \u00e0 charge, apr\u00e8s remboursement par l\u2019assurance maladie obligatoire et avant remboursements \u00e9ventuels par l\u2019assurance maladie compl\u00e9mentaire, de 1 550 \u20ac pour une d\u00e9pense totale de 37 280 \u20ac.<\/p>\n\n\n\n

Au-del\u00e0 de ce montant moyen, les r\u00e9sultats mettent en \u00e9vidence le r\u00f4le central des d\u00e9passements d\u2019honoraires dans la constitution du reste \u00e0 charge. Ce ph\u00e9nom\u00e8ne est particuli\u00e8rement marqu\u00e9 pour certaines sp\u00e9cialit\u00e9s m\u00e9dicales, comme les oncologues-radioth\u00e9rapeutes, les gyn\u00e9cologues et les chirurgiens, et pour certains territoires.<\/p>\n\n\n\n

L\u2019analyse a \u00e9galement permis de mettre en lumi\u00e8re des situations sp\u00e9cifiques, comme celle des reconstructions mammaires r\u00e9alis\u00e9es dans le secteur priv\u00e9, qui s\u2019inscrivent pleinement dans le parcours de soins d\u2019un cancer du sein, mais peuvent entra\u00eener des restes \u00e0 charge importants, li\u00e9s aux d\u00e9passements d\u2019honoraires. <\/p>\n\n\n\n

Il \u00e9tait important d\u2019objectiver le poids de ces d\u00e9passements dans le reste \u00e0 charge. En effet, leur couverture par les compl\u00e9mentaires sant\u00e9 est tr\u00e8s variable selon les contrats, ce qui est susceptible de renforcer les in\u00e9galit\u00e9s socio-\u00e9conomiques face aux d\u00e9penses de sant\u00e9.<\/p>\n\n\n\n

Une distinction au congr\u00e8s EMOIS 2026<\/strong><\/h2>\n\n\n\n

Les r\u00e9sultats de l\u2019analyse de la Cour, pr\u00e9sent\u00e9s lors du congr\u00e8s d\u2019information m\u00e9dicale EMOIS 2026, ont re\u00e7u le prix de la meilleure communication affich\u00e9e pour le poster intitul\u00e9 \u00ab Reste \u00e0 charge des femmes atteintes d’un cancer du sein apr\u00e8s remboursement de l’assurance maladie obligatoire \u00bb.<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

Cette distinction souligne l’int\u00e9r\u00eat scientifique et op\u00e9rationnel de travaux r\u00e9alis\u00e9s dans le cadre d’une \u00e9valuation de politique publique. Elle illustre \u00e9galement le r\u00f4le du d\u00e9partement \u00ab\u00a0Analyse et sciences des donn\u00e9es\u00a0\u00bb de la Cour des comptes : transformer des donn\u00e9es complexes, en informations utiles pour \u00e9clairer les constats, objectiver les in\u00e9galit\u00e9s observ\u00e9es et renforcer la pertinence et l\u2019impact des \u00e9valuations des politiques publiques.<\/p>\n\n\n\n

Lien vers le rapport et son cahier m\u00e9thodologique<\/a><\/p>\n\n\n\n

\"\"
L’auteure, Appoline Chariot. Source : Appoline Chariot.<\/figcaption><\/figure>\n","protected":false},"excerpt":{"rendered":"

Que paient r\u00e9ellement les femmes atteintes d’un cancer du sein pour se soigner ? 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