Income and the Demand for Complementary Health Insurance in France

This paper examines the demand for complementary health insurance (CHI) in the non-group market in France and the reasons why the near poor seem price insensitive. First we develop a theoretical model based on a simple tradeoff between two goods: CHI and a composite good reflecting all other consumptions. Then we estimate a model of CHI consumption and empirically test the impact of potential determinants of demand for coverage: risk aversion, asymmetrical information, non-expected utility, the demand for quality and health, and supply-side factors such as price discrimination. We interpret our empirical findings in terms of crossed price and income elasticity of the demand for CHI. Last, we use these estimates of elasticity to simulate the effect of various levels of price subsidies on the demand for CHI among those with incomes around the poverty level in France. We find that the main motivation for purchasing CHI in France is protection against the financial risk associated with co-payments in the public health insurance scheme. We also observe a strong income effect suggesting that affordability might be an important determinant. Our simulations indicate that no policy of price subsidy can significantly increase the take-up of CHI among the near poor; any increase in the level of subsidy generates a windfall benefit for richer households.Demand for health insurance, Uninsured, Premium subsidies

Coûts de l’autoprotection et équilibre d’un marché de l’assurance concurrentiel

This paper considers a competitive insurance market under moral hazard and adverse selection, in which both the agent’s preventive effort and self protection costs are unobservable by the insurance companies. We show that the agent provides the same level of self-protection than without adverse selection. The agent who has a higher marginal cost is proposed his moral hazard contract whereas adverse selection may make the lower marginal cost agent’s coverage to decrease. Finally, equilibrium may not exist. Nous considérons un marché concurrentiel de l’assurance en présence d’aléa moral dans lequel le niveau du coût de l’autoprotection de l’assuré est son information privée. Nous caractérisons alors l’équilibre en contrats du marché en supposant qu’il existe deux types d’agents : un type à faible coût marginal de l’effort et un autre dont le coût marginal est élevé. D’une part, nous montrons que le niveau de l’autoprotection de l’agent à l’équilibre est le même que dans la situation d’aléa moral pur. D’autre part, nous montrons qu’à l’équilibre les agents dont le coût marginal de l’effort est élevé obtiennent le même contrat que dans la situation d’aléa moral pur alors que l’autre type d’agents peut obtenir une couverture d’assurance plus faible. Enfin, l’existence de l’équilibre n’est pas toujours garantie.

Les franchises ont-elles modifié les comportements d’achats de médicaments : une étude à partir de données déclaratives d’ESPS 2008.

Médicaments;

Nonurgent patients in the emergency department? A French formula to prevent misuse

<p>Abstract</p> <p>Background</p> <p>Overcrowding in emergency department (EDs) is partly due to the use of EDs by nonurgent patients. In France, the authorities responded to the problem by creating primary care units (PCUs): alternative structures located near hospitals. The aims of the study were to assess the willingness of nonurgent patients to be reoriented to a PCU and to collect the reasons that prompted them to accept or refuse.</p> <p>Methods</p> <p>We carried out a cross sectional survey on patients' use of EDs. The study was conducted in a French hospital ED. Patients were interviewed about their use of health services, ED visits, referrals, activities of daily living, and insurance coverage status. Patients' medical data were also collected.</p> <p>Results</p> <p>85 patients considered nonurgent by a triage nurse were asked to respond to a questionnaire. Sex ratio was 1.4; mean age was 36.3 +/- 11.7 years.</p> <p>Most patients went to the ED autonomously (76%); one third (31.8%) had consulted a physician. The main reasons for using the ED were difficulty to get an appointment with a general practitioner (22.3%), feelings of pain (68.5%), and the availability of medical services in the ED, like imaging, laboratory tests, and drug prescriptions (37.6%). Traumatisms and wounds were the main medical reasons for going to the ED (43.5%).</p> <p>More than two-thirds of responders (68%) were willing to be reoriented towards PCUs. In the multivariate analysis, only employment and the level of urgency perceived by the patient were associated with the willingness to accept reorientation. Employed persons were 4.5 times more likely to accept reorientation (OR = 4.5 CI (1.6-12.9)). Inversely, persons who perceived a high level of urgency were the least likely to accept reorientation (OR = 0.9 CI (0.8-0.9).</p> <p>Conclusions</p> <p>Our study provides information on the willingness of ED patients to accept reorientation and shows the limits of its feasibility. Alternative structures such as PCUs near the ED seem to respond appropriately to the growing demands of nonurgent patients. Reorientation, however, will be successful only if the new structures adapt their opening hours to the needs of nonurgent patients and if their physicians can perform specific technical skills.</p

Real estate sales by public entities

Régulièrement évoquées dans la doctrine à la faveur généralement des commentaires et notes de jurisprudence, les ventes immobilières des personnes publiques n'ont jamais fait l'objet d'une étude spécifique et globale. La présente étude se propose de se livrer à cette tâche pour mieux appréhender cette modalité de valorisation qui occupe une place de choix dans les stratégies de gestion domaniale des personnes publiques. En effet, en vue de valoriser les biens immobiliers leur appartenant, les personnes publiques utilisent les ventes immobilières de façon diversifiée. Elles y ont généralement recours soit comme moyen de performance immobilière tendant notamment à la rétraction des parcs publics immobiliers, soit comme instrument de poursuite d'objectifs d'intérêt général. Une telle utilisation diversifiée entraine l'usage de techniques contractuelles hétéroclites qui soulèvent des questions juridiques parfois très complexes. Cette utilisation des ventes d'immeubles publics est facilitée par l'émergence d'un droit des propriétés publiques particulièrement favorable à la valorisation par l'aliénation. En témoigne les aménagements de plus en plus appuyés apportés aux principes de l'inaliénabilité du domaine public et de l'incessibilité à vils prix des biens publics. Conjuguée avec la personnalité juridique publique des vendeurs, l'usage de la vente des biens publics immobiliers à des fins variées aboutit à la singularisation et à l'éclatement du régime juridique de tels contrats publics. Qu'on songe par exemple au régime décisionnel en la matière, au régime de passation ou au régime contentieux de ces contrats. La recherche propose d'en rendre compte et de suggérer des solutions tendant à en unifier le régime juridique.Regularly mentioned in doctrine generally in favor of commentaries and case law notes, real estate sales by public entities have never been the subject of a specific and comprehensive study. The present study proposes to undertake this task in order to better understand this valuation method which occupies a prominent place in the land management strategies of public persons. In fact, in order to enhance the value of real estate belonging to them, public bodies use real estate sales in a variety of ways. They generally use it either as a means of real estate performance tending in particular to the retraction of public real estate stocks, or as an instrument for the pursuit of general interest objectives. Such a diversified use leads to the use of heterogeneous contractual techniques which raise sometimes very complex legal questions. This use of sales of public buildings is facilitated by the emergence of public property rights that are particularly favorable to valuation through alienation. This is evidenced by the increasingly strong adjustments made to the principles of the inalienability of the public domain and the inaccessibility of public goods at low prices. Combined with the public legal personality of the sellers, the use of the sale of public real estate for various purposes in connection with the singling out and breaking up of the legal regime of such public contracts. One thinks, for example, of the decision-making regime in the matter, the awarding regime or the litigation regime of these contracts. The research proposes to account for this and to suggest solutions tending to unify the legal regime

Comparative Effects of Di-(2-ethylhexyl)phthalate and Di-(2-ethylhexyl)terephthalate Metabolites on Thyroid Receptors: In Vitro and In Silico Studies

Plasticizers added to polyvinylchloride (PVC) used in medical devices can be released into patients’ biological fluids. Di-(2-ethylhexyl)phthalate (DEHP), a well-known reprotoxic and endocrine disruptor, must be replaced by alternative compounds. Di-(2-ethylhexyl) terephthalate (DEHT) is an interesting candidate due to its lower migration from PVC and its lack of reprotoxicity. However, there is still a lack of data to support the safety of its human metabolites with regard to their hormonal properties in the thyroid system. The effects of DEHT metabolites on thyroid/hormone receptors (TRs) were compared in vitro and in silico to those of DEHP. The oxidized metabolites of DEHT had no effect on T3 receptors whereas 5-hydroxy-mono-(ethylhexyl)phthalate (5-OH-MEHP) appeared to be primarily an agonist for TRs above 0.2 µg/mL with a synergistic effect on T3. Monoesters (MEHP and mono-(2-ethylhexyl)terephthalate, MEHT) were also active on T3 receptors. In vitro, MEHP was a partial agonist between 10 and 20 µg/mL. MEHT was an antagonist at non-cytotoxic concentrations (2–5 µg/mL) in a concentration-dependent manner. The results obtained with docking were consistent with those of the T-screen and provide additional information on the preferential affinity of monoesters and 5-OH-MEHP for TRs. This study highlights a lack of interactions between oxidized metabolites and TRs, confirming the interest of DEHT

Optimisation de l'emploi des dispositifs médicaux en perfusion, hémodialyse et nutrition parentérale (études toxicologiques, pharmacologiques et cliniques des phtalates, étude des interactions contenant-contenu : application aux poches multicouches, suivi plasmatique et dialysance de la naltrexone chez les patients hémodialysés)

LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

Prévention des risques en présence d’asymétries d’information : quelques résultats théoriques

La prévention est une dimension essentielle de la gestion des risques. L’assurance permet de couvrir les risques mais ne permet pas toujours de mettre en oeuvre les niveaux de prévention optimaux à cause des asymétries d’information entre assureurs et assurés. Les incitations à la prévention des risques de responsabilité civile sont, elles aussi, touchées par les problèmes d’information. De plus, pour gérer cette catégorie de risques, une attention particulière doit être portée à la capacité financière des responsables à supporter les externalités qu’ils génèrent ainsi qu’aux garanties financières qui peuvent être offertes aux agents pouvant rencontrer une limite de solvabilité.Prevention is an essential aspect of risk management. Insurance makes it possible to cover risks, but does not always allow implementing the optimal level of prevention because of asymmetric information between insurers and policyholders. Prevention of liability risks is also affected by asymmetric information but a key point when considering this kind of risk is the potential insolvency of the injurer party. A particular attention may be devoted to the financial ability of injurers and financial guarantees that can be offered to those who can be bankrupted by their liability

Coûts de l’autoprotection et équilibre d’un marché de l’assurance concurrentiel

Nous considérons un marché concurrentiel de l’assurance en présence d’aléa moral dans lequel le niveau du coût de l’autoprotection de l’assuré est son information privée. Nous caractérisons alors l’équilibre en contrats du marché en supposant qu’il existe deux types d’agents : un type à faible coût marginal de l’effort et un autre dont le coût marginal est élevé. D’une part, nous montrons que le niveau de l’autoprotection de l’agent à l’équilibre est le même que dans la situation d’aléa moral pur. D’autre part, nous montrons qu’à l’équilibre les agents dont le coût marginal de l’effort est élevé obtiennent le même contrat que dans la situation d’aléa moral pur alors que l’autre type d’agents peut obtenir une couverture d’assurance plus faible. Enfin, l’existence de l’équilibre n’est pas toujours garantie.This paper considers a competitive insurance market under moral hazard and adverse selection, in which both the agent’s preventive effort and self protection costs are unobservable by the insurance companies. We show that the agent provides the same level of self-protection than without adverse selection. The agent who has a higher marginal cost is proposed his moral hazard contract whereas adverse selection may make the lower marginal cost agent’s coverage to decrease. Finally, equilibrium may not exist