National Authority for Health: France

Provides an overview of France's National Authority for Health, which defines best-care standards and assesses the benefit and effectiveness of new technologies for inclusion on benefits lists. Examines its use of comparative effectiveness research

Agent model with a monopoly power : physicians

The aim of this paper is to model a liberal profession, in this case physicians. We propose a model in which the physician acts in the same way as an agent who maximises his utility function subject to his budget constraint, while at the same time being able to affect his rate of remuneration. This model presupposes that physicians attempt to reach two target, namely income and leisure, and that the trade-o€ between these two target depends on their monopolistic power. Unlike existing models, our proposed model advances that some physicians may have a disutility for leisure and may adopt altruistic or strategic behaviours. To determine the relevance of our model, we estimate salaried, firm and agent versions of the model based on a sample of 317 physicians practicing in the Provence-Alpes-Côte d'Azur region (PACA). We observe that physicians do not act like a purely profit-maximising firm. Furthermore, they are able to affect their net remuneration rate through their labour supply. The model that we propose therefore is of particular importance. We estimate that around 20% of physicians experience disutility from leisure, which can be explained by their adoption of altruistic and strategic behaviours.Physicians, Income, Econometric Models

Provider Competition in a Dynamic Setting

In this paper, we examine provider and patient behaviour where effort is non-contractible and where competition between providers is modeled in an explicit way. More specifically, we construct a model where physicians repeatedly compete for patients and where patients’ outside options are solved for in equilibrium. In our model, physicians are characterized by an individual-specific ethical constraint which allows for unobserved heterogeneity in the physicians market. By doing so, we introduce uncertainty in the patient’s likely treatment if he were in fact to leave his current physician to seek care elsewhere. We find that competition between providers may serve as an important incentive for physicians in treating their patients with desired levels of care.Physician Payment Mechanisms, Physician heterogeneity, Competition, Information Asymmetry, Insurance.

Optimal payment schemes for physicians

Increasingly, physicians’ payment schemes are being reformed to en- hance performance and to ensure an optimal allocation of scarce medical resources. The empirical evidence points towards the use of mixed payment schemes that appear better at achieving efficiency than either lump sum payments (such as cap- itation) or piece rates (fee for service). Yet, this alleged superiority remains to be established from a theoretical standpoint. The Principal-Agent model developed in this paper offers a contribution in this line, with a primary care physician as agent and a public regulator as principal. Alternative specifications of the princi- pal’s objective function are considered in the model (efficiency versus fairness). Uncertainty is introduced by two random variables that represent the probability for an individual of being ill and his productivity parameter which determines the amount of resources (the physician’s effort in particular) necessary to restore health. The relationship is characterised by information asymmetry since the physician is assumed to observe both variables after the contract has been signed, but before choosing his effort level. Both selection and moral hazard issues are addressed in the model and the results show that, under GP risk neutrality, mixed payment schemes fully correct for both types of information asymmetry.info:eu-repo/semantics/publishedVersio

Agent model with a monopoly power : physicians

The aim of this paper is to model a liberal profession, in this case physicians. We propose a model in which the physician acts in the same way as an agent who maximises his utility function subject to his budget constraint, while at the same time being able to affect his rate of remuneration. This model presupposes that physicians attempt to reach two target, namely income and leisure, and that the trade-o between these two target depends on their monopolistic power. Unlike existing models, our proposed model advances that some physicians may have a disutility for leisure and may adopt altruistic or strategic behaviours. To determine the relevance of our model, we estimate salaried, firm and agent versions of the model based on a sample of 317 physicians practicing in the Provence-Alpes-Côte d'Azur region (PACA). We observe that physicians do not act like a purely profit-maximising firm. Furthermore, they are able to affect their net remuneration rate through their labour supply. The model that we propose therefore is of particular importance. We estimate that around 20% of physicians experience disutility from leisure, which can be explained by their adoption of altruistic and strategic behaviours. [Authors]]]> Physicians ; Income ; Models, Econometric eng https://serval.unil.ch/resource/serval:BIB_593001751D8A.P001/REF.pdf http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_593001751D8A7 info:eu-repo/semantics/altIdentifier/urn/urn:nbn:ch:serval-BIB_593001751D8A7 info:eu-repo/semantics/submittedVersion info:eu-repo/semantics/openAccess Copying allowed only for non-profit organizations https://serval.unil.ch/disclaimer application/pdf oai:serval.unil.ch:BIB_593006E8D85F 2022-05-07T01:18:26Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_593006E8D85F Réactions émotionnelles chez les patients en traitement palliatif info:doi:10.4414/fms.2017.03138 info:eu-repo/semantics/altIdentifier/doi/10.4414/fms.2017.03138 Savioz, Véronique Guex, Patrice info:eu-repo/semantics/article article 2017-12-06 Forum Medical Suisse, vol. 17, no. 49, pp. 1087-1093 info:eu-repo/semantics/altIdentifier/pissn/1661-6138 fre https://serval.unil.ch/resource/serval:BIB_593006E8D85F.P001/REF.pdf http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_593006E8D85F5 info:eu-repo/semantics/altIdentifier/urn/urn:nbn:ch:serval-BIB_593006E8D85F5 info:eu-repo/semantics/publishedVersion info:eu-repo/semantics/openAccess Copying allowed only for non-profit organizations https://serval.unil.ch/disclaimer application/pdf oai:serval.unil.ch:BIB_5930881AAFA5 2022-05-07T01:18:26Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_5930881AAFA5 Analyse de la mobilité criminelle entre les cantons de Genève et Vaud (2009-2012) Grossrieder, L. Chopin, J. Jendly, M. Ecole des sciences criminelles (ESC) info:eu-repo/semantics/report techreport 2013 fre oai:serval.unil.ch:BIB_5930D29F2172 2022-05-07T01:18:26Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_5930D29F2172 Rate and mechanism of the photoreduction of birnessite (MnO2) nanosheets info:doi:10.1073/pnas.1421018112 info:eu-repo/semantics/altIdentifier/doi/10.1073/pnas.1421018112 http://www.pnas.org/content/112/15/4600.short Marafatto, Francesco Femi Strader, Matthew L. Gonzalez-Holguera, Julia Schwartzberg, Adam Gilbert, Benjamin Peña, Jasquelin info:eu-repo/semantics/article article 2015-03 Proceedings of the National Academy of Sciences, vol. 112, no. 15, pp. 4600-4605 info:eu-repo/semantics/altIdentifier/pissn/0027-8424 info:eu-repo/semantics/altIdentifier/eissn/1091-6490 urn:issn:0006-2952 <![CDATA[The photoreductive dissolution of Mn(IV) oxide minerals in sunlit aquatic environments couples the Mn cycle to the oxidation of organic matter and fate of trace elements associated with Mn oxides, but the intrinsic rate and mechanism of mineral dissolution in the absence of organic electron donors is unknown. We investigated the photoreduction of δ-MnO2 nanosheets at pH 6.5 with Na or Ca as the interlayer cation under 400-nm light irradiation and quantified the yield and timescales of Mn(III) production. Our study of transient intermediate states using time-resolved optical and X-ray absorption spectroscopy showed key roles for chemically distinct Mn(III) species. The reaction pathway involves (i) formation of Jahnâeuro"Teller distorted Mn(III) sites in the octahedral sheet within 0.6 ps of photoexcitation; (ii) Mn(III) migration into the interlayer within 600 ps; and (iii) increased nanosheet stacking. We propose that irreversible Mn reduction is coupled to hole-scavenging by surface water molecules or hydroxyl groups, with associated radical formation. This work demonstrates the importance of direct MnO2 photoreduction in environmental processes and provides a framework to test new hypotheses regarding the role of organic molecules and metal species in photochemical reactions with Mn oxide phases. The timescales for the production and evolution of Mn(III) species and a catalytic role for interlayer Ca2+ identified here from spectroscopic measurements can also guide the design of efficient Mn-based catalysts for water oxidation

Concurrence et antisélection en assurance maladie : l’expérience des Pays-Bas

Quels sont les bénéfices mais aussi les écueils attendus du renforcement de la concurrence sur le marché de l’assurance maladie ? L’intervention de l’Etat demeure-t-elle justifiée ? Quelles sont les modalités optimalesd’une telle intervention ? Autant d’interrogations auxquelles le présent article tente d’apporter des éclairages à partir de la confrontation des résultats de la théorie microéconomique de l’assurance à l’expérience pratique du système de santé des Pays-Bas dans ce domaine.Which are the benefits but also the pitfalls to be expected from strengthening competition in the health insurance markets ? Is State intervention still legitimate ? Which are the optimal forms it should take ? These are some of the questions addressed in this paper whixh confronts the theorical predictions from insurance economics with the practical experience of the Dutch health care system

Concurrence et antisélection en assurance maladie : l’expérience des Pays-Bas

Quels sont les bénéfices mais aussi les écueils attendus du renforcement de la concurrence sur le marché de l’assurance maladie ? L’intervention de l’Etat demeure-t-elle justifiée ? Quelles sont les modalités optimalesd’une telle intervention ? Autant d’interrogations auxquelles le présent article tente d’apporter des éclairages à partir de la confrontation des résultats de la théorie microéconomique de l’assurance à l’expérience pratique du système de santé des Pays-Bas dans ce domaine.Which are the benefits but also the pitfalls to be expected from strengthening competition in the health insurance markets ? Is State intervention still legitimate ? Which are the optimal forms it should take ? These are some of the questions addressed in this paper whixh confronts the theorical predictions from insurance economics with the practical experience of the Dutch health care system

Partage optimal entre assurance maladie privée et publique : la situation française au regard d’expériences étrangères

En France, l’assurance maladie complémentaire couvre désormais plus de neuf personnes sur dix et a vocation à s’étendre encore. Cette généralisation progressive ainsi que les initiatives de gestion du risque prises par certains des opérateurs ont progressivement conduit à questionner sa place par rapport à celle de l’assurance obligatoire et, de manière plus générale, son rôle dans le système de santé. Cette question se pose dans la plupart des pays industrialisés, malgré des configurations, au départ très variables. Elle rejoint celle, plus générale, des rôles respectifs du marché et de l’État, qui, dans les secteurs tels que l’éducation ou la santé, ont fait et continuent de faire l’objet d’un débat nourri.In France, private complementary health insurance covers nine out of ten individuals and the intention is to exend it further. This progressive generalisation coupled with the recent initiatives taken by private insurers to better manage health risks has led to a questioning of the relationship between such private schemes and the public compulsory health insurance fund, and more generally, of the role of such schemes in the health care system. This questioning is common to most industrialised countries although under variable forms. It comes to defining the respective roles of the State and the market which, in certain sectors such as education and health, still remains highly contentious

Origine sociale et état de santé des parents : Quelle influence sur l’état de santé à l’âge adulte ?.

Parmi les facteurs explicatifs proposés pour expliquer les inégalités sociales de santé, la littérature épidémiologique a récemment mis en avant l’influence du milieu social d’origine sur l’état de santé à l’âge adulte, cette influence résultant à la fois d’un effet direct des conditions de vie dans l’enfance sur la santé (latency model) et d’un effet indirect passant par l’influence du milieu d’origine sur le statut socioéconomique de l’enfant (pathway model). Par ailleurs, on peut supposer une influence directe de l’état de santé des parents sur celui des enfants, s’expliquant non seulement par un patrimoine génétique commun mais aussi par une transmission des comportements liés à la santé. A partir d’une exploitation de l‘enquête SHARE, cette recherche propose d’explorer ces trois modèles, pour la première fois en France, en étudiant le rôle de la profession des deux parents et de leur état de santé, sur l’état de santé d’un individu à l’âge adulte, contrôlé par son statut socioéconomique. Les résultats montrent que l’état de santé à l’âge adulte, au-delà de son association avec la situation sociale actuelle de l’individu, n’est pas indépendant de l’origine sociale ni de l’état de santé des parents. La santé à l’âge adulte semble être directement influencée par le statut socioéconomique de la mère et l’état de santé des deux parents, le statut socioéconomique du père ayant au contraire une influence indirecte passant par la détermination du statut socioéconomique de l’enfant. Ces résultats suggèrent ainsi l’existence en France d’une inégalité des chances en matière de santé.Egalités des chances; inégalités de santé; transmission intergénérationnelle; early life hypothesis;