Changing time and emotions

In this paper, we consider that our experience of time (to come) depends on the emotions we feel when we imagine future pleasant or unpleasant events. A positive emotion such as relief or joy associated with a pleasant event that will happen in the future induces impatience. Impatience, in our context, implies that the experience of time up to the forthcoming event expands. A negative emotion such as grief or frustration associatedwith an unpleasant event thatwill happen in the future triggers anxiety. This will give the experience of time contraction. Time, therefore, is not exogeneously given to the individual and emotions, which link together events or situations, are a constitutive ingredient of time experience. Our theory can explain experimental evidence which shows that people tend to prefer to perform painful actions earlier than pleasurable ones, contrary to the predictions yielded by the standard exponential discounting framework.experience of time ; emotions ; impatience ; anxiety ; discount factor ; time preference

Reforming incentive schemes under political constraints: The physician agency

In many developed countries attempts to reform physicians payment schemes have failed. To analyze some of the difficulties, this paper studies reforms of payment schemes in situations such as the physician agency, where the quality of the good produced is imperfectly observable by the payer. We first study the situation, common in many countries, where physicians face a single scheme. We identify conditions under which no reform can both obtain the consent of a large proportion of physicians (political constraints) and improve patients welfare. We then study whether a menu of contracts, with or without cross subsidies, may solve the difficulties generated by the heterogeneity of producers practice. /// Dans de nombreux pays, les réformes visant à modifier les modes de rémunération des prescripteurs de soins se sont heurtées à leur forte opposition. Ce papier analyse ces difficultés, d'abord dans un cadre de monopole puis de concurrence régulée entre différentes organisations. Quelques facteurs clefs sont mis en évidence: ils sont liés au pouvoir politique des médecins, à l'hétérogénéité de leurs caractéristiques et de leurs comportements.Health; Insurance; Equity

Therapeutic non adherence: a rational behavior revealing patient preferences ?

This paper offers an indirect measure of patient welfare based on whether patients comply with the prescription they receive. Adherence behavior is supposed to reveal patients' subjective valuations of particular therapies. We write a simple theoretical model of patient adherence behavior, that reflects the trade-off between perceived costs and observed regimen efficacy. A discrete choice framework is then used for the estimation, ie the comparison of the incremental benefit of drug intake between two regimens. Consequently, the empirical analysis is based on the identification of patient and drug characteristics associated with adherence. The econometric approach is implemented through a bivariate panel two-equation simultaneous system studying jointly the factors associated with adherence and response to treatment. The data come from a randomized clinical trial conducted in France between 1999 and 2001 and comparing the efficacy of 2 tritherapy strategies in HIV disease. Both the theoretical and empirical results suggest that, for comparable clinical efficacy and toxicity levels, a higher adherence level is associated with higher patient welfare, thus adding valuable information to conclusions drawn by a mere biostatistical analysis. Therefore, from the perspective of the patient, the adherence-enhancing drug must be favored. Our results based on panel data also stress that unobserved patient characteristics account substantially for drug valuation and that the assessment evolves during the course of the treatment. Furthermore, we provide a new framework for the analysis of adherence data. The microeconometric framework highlights that non adherence is an endogenous behavior, thus suggesting new ways for improving adherence.drug valuation method ; revealed preferences ; endogenous adherence behavior ; panel bivariate probit estimation ; HIV

Workplace smoking ban effects in an heterogeneous smoking population

Many public policies, and especially health policies, are aimed at modifying individual behavior. This is particularly true of anti smoking policies. However, health behavior is highly heterogeneous, and so are individual responses to public policies such as taxes or restriction on use. We investigate the effect of a workplace smoking ban which took place in France in 2007. By its national aspect, the French reform offers a good case to study the effect of workplace smoking bans. Using original data on patients who consult tobacco cessation services, we show that the ban caused an increase in the demand for such services, and in the number of successful attempts to quit smoking. However, using survey data, we show that the ban had no measurable effect on overall prevalence in the general population. Models of quasi rational smoking behavior may offer an explanation for these two apparently contradictory findings.workplace smoking ban ; tobacco control ; smoking cessation ; impact evaluation

The influence of supplementary health insurance on switching behaviour : evidence on Swiss data

This paper focuses on the switching behaviour of sickness fund enrollees in the Swiss health insurance system. Even though the new Federal Law on Social Health Insurance (LAMal) was implemented in 1996 to promote competition among health insurers, there still remains large premium variations within cantons. This indicates that competition has not been able so far to lead to a single price, and reveals some inertia among consumers who seem reluctant to switch to less expensive funds. We investigate one possible barrier to switching behaviour, namely the influence of the supplementary insurance on the choice for basic insurance plan in Switzerland, which has not been studied so far. Our aim is to analyse the two decisions (choice of health plan, subscription to supplementary insurance contracts). We use the data of the OFAS survey conducted in 2000 on health plan choice and import some additional data on the sickness funds (number of enrollees, premiums). The decision to switch is estimated by both logit and a fixed-effects logit models; two main explanatory variables are studied: premiums (for basic insurance contracts) and supplementary insurance. The results suggest that holding a supplementary insurance contract substantially decreases the propensity to switch. The switching decision is positively influenced by the expected gain of switching, measured by the premium differential. The expected gain of switching is higher for switchers with no supplementary insurance (CHF 19.44) than for switchers with supplementary insurance (CHF 13.06). The income level has a direct positive influence on the propensity to buy a supplementary insurance. This finding suggests that the purchase of supplementary insurance is influenced, not only by risk aversion, but also by the willingness to pay for the goods covered by the supplementary insurance, which would be higher for rich people. Bad health has a negative influence on the subscription to a supplementary contract, but is no longer significant when the income is introduced into the specification. All the information about health is captured by the income level, a low income being strongly correlated with a bad health status. Income and a supplementary insurance contract are observable by the insurance company, and can be used as tools for selection.Health Insurance, Private Sector

The influence of supplementary health insurance on switching behaviour: evidence on Swiss data

This paper focuses on the switching behaviour of sickness fund enrolees in the Swiss health insurance system. Even though the new Federal Law on Social Health Insurance (LAMal) was implemented in 1996 to promote competition among health insurers in basic insurance, there still remains large premium variations within cantons. This indicates that competition has not been able so far to lead to a single price, and reveals some inertia among consumers who seem reluctant to switch to less expensive funds. We investigate one possible barrier to switching behaviour, namely the influence of the supplementary insurance. Our aim is to analyse two decisions (switching decision in basic insurance, subscription to supplementary insurance contracts). We use survey data on health plan choice and import some market data related to the sickness funds (number of enrollees, premiums). The decision to switch and the decision to subscribe to a supplementary contract are estimated both separately and jointly. The results suggest that holding a supplementary insurance contract substantially decreases the propensity to switch. However the impact of supplementary insurance is not significant when the individual assesses his/her health as "very good" ; to the contrary, holding a supplementary contract significantly reduces the propensity to switch when the indivual's subjective health status deteriorates. Futhermore, the switching decision is positively influenced by the expected gain of switching. In comparison with the range of the premium difference, the limitations to switch due to the supplementary insurance is moderate, though non negligible. As for the decision to subscribe a supplementary contract, the results show that the income level has a direct positive influence on the propensity to buy a supplementary insurance. Our results suggest that a major mechanism is going on in relation to supplementary insurance: holding a supplementary contract might stop individuals from switching when the individual thinks that she/he could be regarded as a bad risk due to the selection practices that are allowed in supplementary insurance markets. This result bears major policy implications concerning the regulation of basic and supplementary insurance markets.competition in health insurance ; switching behaviour ; premium convergence ; influence of supplementary insurance

Decomposition of Bivariate Inequality Indicesby Attributes

We provide, for the class of relative bidimensional inequality indices, adecomposition of inequality into two univariate Atkinson-Kolm-Senindices and a third statistic which depends on the joint distribution ofresources.multidimensional inequality, relative indices, correlationincreasing transfers, copulas.

Separating selection and incentive effects in health insurance

This paper provides an analysis of the health insurance and health care consumption. A structural microeconomic model of joint demand for health insurance and health care is developed and estimated using full maximum likelihood method using Swiss insurance claims data for over 60 000 adult individuals. The estimation strategy relies on the institutional features of the Swiss system, in which each individual chooses among the same menu of contracts, ranked by the size of their deductible. The empirical analysis shows strong and robust evidence of selection effects. Nevertheless, once selection effects are controlled for, an important incentive effect ("ex-post moral hazard") remains. A decrease in the copayment rate from 100% to 10% increases the marginal demand for health care by about 90% and from 100% to 0% by about 150%. The correlation between insurance coverage and health care expenditures may be decomposed into the two effects: 75% may be attributed to selection, and 25 % to incentive effects.health insurance ; demand for health care ; moral hazard ; adverse selection ; full maximum likelihood estimation

Decomposition of bivariate inequality indices by attributes

We provide, for the class of relative bidimensional inequality indices, a decomposition of inequality into two univariate Atkinson- Kolm-Sen indices and a third statistic which depends on the joint distribution of resources.multidimensional inequality ; relative indices ; correlation increasing transfers ; copulas

Perspective générale : santé, santé publique

Pierre-Yves Geoffard, directeur détudes Compte rendu non communiqu