What are GPs' preferences for financial and non-financial incentives in cancer screening? Evidence for breast, cervical, and colorectal cancers

We benefited for this research from grants provided by the French National Institute for Cancer (INCa) (INCA_7014). We would like to thank Dr Diane Skatun, Mary Kilonzo, and the three anonymous reviewers for their useful comments on the paper.Peer reviewedPostprin

Subscribing to Supplemental Health Insurance in France: A Dynamic Analysis of Adverse Selection

Adverse selection, which is well described in the theoretical literature on insurance, remains relatively difficult to study empirically. The traditional approach, which focuses on the binary decision of “covered” or “not”, potentially misses the main effects because heterogeneity may be very high among the insured. In the French context, which is characterized by universal but incomplete public health insurance (PHI), we study the determinants of the decision to subscribe to supplemental health insurance (SHI) in addition to complementary health insurance (CHI). This work permits to analyze health insurance demand at the margin. Using a panelized dataset, we study the effects of both individual state of health, which is measured by age and previous individual health spending, and timing on the decision to subscribe. One striking result is the changing role of health risk over time, illustrating that adverse selection occurs immediately after the introduction of SHI. After the initial period, the effects of health risks (such as doctors’ previous health expenditures) diminish over time and financial risks (such as dental and optical expenses and income) remain significant. These results may highlight the inconsistent effects of health risks on the demand for insurance and the challenges of studying adverse selection.Supplemental health insurance, adverse selection, health insurance demand, longitudinal analysis.

Private supplemental health insurance: retirees' demand

In France, private health insurance, that supplements public health insurance, is essential for access to health care. About 90% of the population is covered by a private contract and around half of them obtain their coverage through their employer. Considering the financial benefits associated with group contracts compared to individual contracts, we assume that the switching behaviors vary among different beneficiaries during the transition to retirement. Indeed, despite a 1989 law, the gap in premiums increases at retirement between group and individual contracts affords the opportunity to study the marginal price effect on switching behaviors. In this study, we consider the nature of the contract prior to retirement (compulsory or voluntary membership group contract and individual contract) as an indirect measure of the price effect. We focus on its role and check for a large number of individual characteristics that may influence the new retirees' health insurance demand.private health insurance, retirement, switching behavior

Mécanismes de rémunération et incitations des médecins

La rémunération des médecins est au coeur de nombreuses tentatives de réformes. Nous montrons dans cet article pourquoi il est si difficile pour un gouvernement (lorsqu’il est l’assureur) d’instaurer un système de paiement optimal. Un patient représentatif peut contracter deux types de maladies (grave ou bénigne). Si la qualité du diagnostic est endogène, le gouvernement ne peut plus instaurer un système qui favorise simultanément la qualité, en incitant le médecin à fournir un effort, et réduise les dépenses, en évitant les prescriptions excessives (demande induite).The design of reimbursement schemes of health care providers is a main issue in most reforms. We show in this paper why it is so difficult for a government (which is also the insurer) to implement an optimal mechanism. The representative consumer can incur two types of illness (serious or benign). If the quality of the diagnosis is  depending on an effort of the physician, it is no longer possible for the government to implement a system which, at the same time, favours the quality and prevents the increasing in health expenses (induced demand)

Tarif forfaitaire de responsabilité : quels impacts sur le pharmacien ?

L'objectif de cet article est d'étudier l'impact du tarif forfaitaire de responsabilité (TFR) sur la part de la marge du grossiste attribuée au pharmacien et sur l'effort de substitution entre marque et générique. Nous considérons une situation dans laquelle le génériqueur vend directement son générique au pharmacien et le laboratoire de marque vend son princeps par l'intermédiaire d'un grossiste. Nous supposons que les produits sont verticalement différenciés et nous résolvons un jeu en deux étapes. A la première étape, le génériqueur détermine la part de la marge du grossiste qu'il consent au pharmacien afin de l'inciter à substituer et, si un tarif forfaitaire de responsabilité est introduit, les firmes se concurrencent en prix. A la seconde étape, le pharmacien choisit son effort de substitution. Nous montrons que l'introduction du TFR augmente la part de la marge du grossiste allouée au pharmacien par le génériqueur, mais diminue l'effort de substitution du pharmacien

Introduction to the Thematic Section on Health Economics

International audienc

Introduction

Franc Carine. Introduction. In: Economie et Statistique / Economics and Statistics, n°524-525, 2021. pp. 5-9

Le partage de la couverture maladie entre assurances obligatoire et complémentaires

International audienc