Demande de traitement et risque exogène

La perception des risques médicaux et l'attitude des médecins et des patients face à ceux-ci jouent un rôle essentiel dans les choix en matière de santé. La littérature économique a dès lors cherché à intégrer la façon dont les risques influencent les préférences des patients dans les modèles représentant les prises de décisions médicales. Les précurseurs en la matière étant incontestablement Pauker et Kassirer (1975) et (1980) avec deux articles traitant respectivement de la décision de traitement en présence de risques diagnostiques et de l'apport des tests diagnostiques. A leur suite, d'autres contributions (Eeckhoudt, Lebrun, Sailly (1984) et (1985), Doubilet (1984) entre autres) vont utiliser la théorie du risque pour éclairer les choix médicaux. L'hypothèse dominante dans cette littérature est qu'il n'existe qu'une seule source de risque, portant soit sur l'état de santé du patient, soit sur sa durée de vie espérée

How can allocative inefficiency reveal risk preference? An empirical investigation on French wheat farms

We focus on a simple framework on wheat producer behaviour in a context of price output uncertainty. More precisely, we establish a relationship between ex post output price level and allocative inefficiency that allows to characterize farmers’ risk preferences. Given this analysis, the connection between risk aversion and other socioeconomic variables (such as degree of output specialisation, total asset, debts, farmer’s age…) can furthermore empirically be explored. This relationship is empirically tested on an unbalanced panel including about 650 wheat producers located in the French Department of Meuse over 1992- 2003.Producer behaviour, allocative inefficiency, risk aversion, Crop Production/Industries, Risk and Uncertainty,

On the intensity of downside risk aversion

The degree of downside risk aversion (or equivalently prudence) is so far usually measured by -U'''/U''. We propose here another measure, U'''/U', which has interesting properties, different from those related to -U'''/U''. It also appears that the two measures are not mutually exclusive. Instead, they seem to be rather complementary as shown through an economic application.downside risk aversion, prudence, local and global properties

Comorbidities in cost benefit analyses of health care

The aim of this paper is to examine the dependency of the benefits of health improvements on comorbid conditions. We find that under plausible conditions regarding the utility function over wealth and health, the willingness to pay for health improvements increases with the severity of the comorbid conditions. This positive relationship between willingness to pay and severity of comorbid conditions has implications both for the empirical elicitation of willingness to pay measures and for applications of cost benefit analysis in health policy

Hospital's activity-based financing system and manager - physician interaction

Hospital financing systems determine major decisions made by physicians and managers within hospitals. This paper examines the impact of the transition toward an activity-based reimbursement system that has emerged in most OCDE countries. We consider two initial situations, one for a private for-profit sector where both hospitals and physicians are paid on a fee-for-service basis and the other for a public sector under prospective budget and salaried physicians. For the private sector, our model focuses on the type of interaction (simultaneous, sequential or joint decision-making games) that should emerge between agents after the indroduction of the activity-based financing system. In the public sector, the elasticity of the demand to the level of inputs seems to play a more crucial rôle in the transition

Impact du passage à la T2A: une modélisation pour l’hôpital public

Nous analysons les conséquences du passage d’un financement par dotation globale à un financement prospectif lié à l’activité et tentons de déterminer en quoi la réforme pourrait être préjudiciable ou bénéfique à la santé financière des hôpitaux publics. Nous développons un modèle théorique qui lie la demande des patients aux décisions conjointes des médecins et des managers d’hôpitaux pour analyser la façon dont le nouveau mode de financement affecte les décisions prises par l’ensemble des agents et donc l’équilibre budgétaire des établissements.Tarification à l’activité, Hôpital public, Equilibre budgétaire

Aversion to Health Inequalities and Priority Setting in Health Care

Traditionally aversion to health inequality is modelled through a concave utility function over health outcomes. Bleichrodt et al. (2004) have suggested a "dual" approach based on the introduction of explicit equity weights. The purpose of this paper is to analyze how priorities in health care are determined in the framework of these two models. It turns out that policy implications are highly sensitive to the choice of the model that will represent aversion to health inequality

Provider payments and patient charges as policy tools for cost-containment: How successful are they in high-income countries?

In this paper, we focus on those policy instruments with monetary incentives that are used to contain public health expenditure in high-income countries. First, a schematic view of the main cost-containment methods and the variables in the health system they intend to influence is presented. Two types of instruments to control the level and growth of public health expenditure are considered: (i) provider payment methods that influence the price and quantity of health care, and (ii) cost-containment measures that influence the behaviour of patients. Belonging to the first type of instruments, we have: fee-for-service, per diem payment, case payment, capitation, salaries and budgets. The second type of instruments consists of patient charges and reference price systems for pharmaceuticals. Secondly, we provide an overview of experience in high-income countries that use or have used these particular instruments. Finally, the paper assesses the overall potential of these instruments in cost-containment policies