Two-part pricing, public discriminating monopoly and redistribution : a note.

This note analyzes some properties of optional two-part pricing in a two-type economy. First, the optimal contracts along the Paretian frontier are described. Then, the duality relation between the Rawlsian program and the discriminating monopoly is demonstrated. Last, this property is used to build a mutualist mechanism implementing the constrained Pareto optima.Monopolies; Pricing; Two-part pricing;

Affordability of complementary health insurance in France : a social experiment.

In order to improve financial access to complementary health insurance (CHI) in France, a CHI voucher program, called Aide Complémentaire Santé (ACS) was introduced in 2005. Four years later, the program covered only 18% of the eligible population. Two main hypotheses are put forward to account for this low take-up rate. The first one is related to the lack of information on the program itself and on its application process. While the second one considers that the amount of the financial support is too small to encourage people to purchase a CHI plan. We conduct a controlled experiment with the National Health Insurance Fund in order to assess these assumptions. A sample of eligible insurees living in an urban area in northern France were randomly split into three groups: a control group who received the standard level of financial aid, a group benefiting from a 75% voucher increase, and a third group benefiting from the same 75% voucher increase plus an invitation to an information meeting on ACS. After six months of follow-up, we observed how many application forms were sent back and how many of them entitled to ACS. Five main conclusions can be drawn from that analysis. (1) The voucher increase has a slight but statistically significant effect on ACS take-up. (2) It also allows better targeting of people actually eligible and thus reduces the number of ACS refusals due to resources above the upper limit. (3) However the invitation to the meeting seems unexpectedly to cancel the positive effect of the voucher increase when both treatments are applied jointly. (4) On the contrary, after controlling for potential selection bias, we observed that attending the briefing has a significant impact on ACS take-up. (5) This study confirms that ACS is complex and reaches poorly its target population. Only 17% of the insurees applied for ACS and only 9% of insures who were invited to the information briefing actually attended it. Moreover, previous CHI holders responded similarly to CHI non holders to treatments, which suggests that the central issue of ACS low take-up rate is not the CHI cost itself but most certainly the access to information, the burden and the complexity of the application process.France; Subsidized Health insurance; low-income population; uninsured; randomized experiment;

Le financement familial de la prise en charge d'une personne âgée dépendante : règles de calcul et critères d'équité dans l'application de l'obligation alimentaire à la française.

Cette communication propose d'analyser, dans une perspective économique, la mise en œuvre de l'obligation alimentaire dans le cadre du financement de la prise en charge de personnes âgées dépendantes. Il s'agit, à partir d'un échantillon de 305 personnes soumises à cette obligation, de comprendre selon quels critères les juges fixent le montant de la participation de certains membres de la famille (enfants, beaux-enfants, petits-enfants) au financement de la prise en charge et quelles en sont les répercussions en termes d'équité intra et inter-familiale.Dépendance,; personnes âgées,; financement; obligation alimentaire; équité;

Moral Intuitions about Social Inequality and Individual Responsibility: A European Comparison.

Responsabilité individuelle; Inégalités;

Social Inequality Factors in the contexts of Education and Health: A European Comparison Based on An Experimental Questionnaire.

Education; Santé; Inégalités;

Family Assistance Configurations for Dependent Older People in Europe,

The Share survey allows us to analyse the assistance given by their children to dependent persons aged 65 and over in European countries. Two types of care are distinguished, according to whether children live with their dependent parent or not. The proportion of dependent older people receiving support from their entourage in one form or another is remarkably constant within countries. In northern countries, the lower level of intergenerational co-residence is offset by the more frequent assistance given by non-cohabiting children. In the six countries studied here, children's involvement is greater when the degree of dependence of the parent is higher and when the parent has no spouse. Where a single parent has two children, on average, the involvement of the younger child seems to depend on that of the elder (the probability that the younger becomes involved seems to be lower if the elder becomes involved), but the reverse is not true.Disabled Elderly, Family Role, Intra-Family Interactions, Caregiving, International Comparisons

La complémentaire santé : un bien normal ?.

Demande d'assurance complémentaire santé;

Affordability of Complementary Health Insurance in France : A Social Experiment.

Inequalities in access to health care are well documented in France. They are mainly explained by inequalities in access to complementary health insurance. Even if the poorest 7% of French residents are covered for most of the out-of-pocket payments by the "free complementary health insurance plan" (Couverture maladie universelle complémentaire, CMUC) since 2000, 8% of the French population remains without any complementary health insurance and this proportion is higher among households whose resources are just above the CMU eligibility threshold. In order to improve financial access to complementary health insurance and reduce the threshold effect induced by the CMUC, a complementary health insurance voucher has been introduced in 2005 for this specific population. Despite a regular increase in uptake, four years after being set up the system concerned only a little over 490,000 people. This result is far below the 2 million people initially targeted. Several hypotheses can explain this evidence : 1. unaffordability of health insurance despite this financial aid, considering that beneficiaries have to pay almost 50% of the price of the contract after the voucher ; 2. lack of information on the take-up administrative process ; 3. voluntary trade-off between private consumption and health coverage. In order to evaluate these different hypotheses, we develop an experiment with the National Health Insurance Fund. Three groups of 1680 eligible households living in urban area in North of France have been randomly selected: a control group benefiting of the current financial aid, a group benefiting of a 50% voucher increase, and a last group benefiting of a 50% voucher increase and a social take-up support. The three groups have been followed-up during 6 months to observe their health insurance purchase. The comparison of the health coverage rate among the three groups will provide some indications on the respective effects of financial incentives and informal barriers on health insurance demand. The experimental data will then be merged with administrative data from the Public Health Insurance Fund to have information on income, supports received, health expenditures of the 2 previous years and health insurance status. A survey is also being conducted among the 3 groups and among a subsample of individuals which previously benefit from the ACS to explore: 1. the determinants of their health insurance status, 2. the determinants of ACS adherence. Finally, the health insurance purchase and the health expenditures will be followed during one year to explore the efficacy of the experiment. Findings from this study will enhance the understanding of the determinants of health insurance demand among the poorest population and help design better public policies to promote access of the poor to health insurance in order to tackle horizontal inequity in access to health care.Subsidized Health insurance; randomized experiment; low-income population; uninsured; France;

Le recours à l’Aide complémentaire santé : les enseignements d’une expérimentation sociale à Lille

Le dispositif de l’Aide complémentaire santé (ACS) a été mis en place au 1er janvier 2005 afin d’inciter les ménages dont le niveau de vie se situe juste au dessus du plafond CMU-C à acquérir une couverture complémentaire santé (CS). Même si le nombre de bénéficiaires a lentement progressé depuis son introduction, le recours à l’ACS reste faible. Deux hypothèses peuvent être formulées pour expliquer cet état de fait : (1) Le défaut d’information sur l’existence du dispositif, son fonctionnement et sur les démarches à entreprendre pour en bénéficier. (2) Le montant de l’aide est insuffisant, une CS resterait trop chère même après déduction de l’aide. Cet article cherche à tester la validité de ces deux hypothèses dans le cadre d’une expérimentation contrôlée au niveau d’une Caisse primaire d’assurance maladie (CPAM) (à Lille). Trois groupes d’assurés ont été aléatoirement constitués ; le premier groupe (groupe témoin) s’est vu proposer le montant d’ACS en vigueur, le deuxième groupe (groupe traité 1) a reçu une proposition d’aide majorée et le troisième groupe (groupe traité 2) a reçu en plus d’une proposition d’aide majorée, une invitation à une réunion d’information sur le dispositif. L’analyse des taux de dossiers de demande retournés par groupe ainsi que le nombre d’ACS accordées rend compte des conclusions suivantes :(1) La majoration du «chèque santé» a un effet faible mais significatif sur le recours à l’ACS. (2) De manière inattendue, l’invitation à la réunion d’information annule l’effet de la majoration du chèque. (3) Assister à la réunion augmente cependant de manière significative la probabilité de retourner un dossier de demande. Cette étude confirme ainsi que l’ACS est un dispositif compliqué qui touche difficilement sa cible. Par ailleurs, les bénéficiaires d’une CS ne répondent pas de manière significativement différente aux non bénéficiaires ce qui laisse à penser que la question centrale du non recours à l’ACS n’est pas celle du coût de la CS mais plus certainement celle de l’accès à l’information et celle du coût et de la difficulté des démarches, l’incertitude pesant sur l’éligibilité étant un facteur aggravant.assurance santé, subvention, expérimentation sociale, ménages pauvres, France.

Les contributions privées au financement de la dépendance dans le cadre de l'obligation alimentaire : pratiques judiciaires et implications macroéconomiques.

L'objectif de cet article est d'analyser les transferts économiques liés à la mise en œuvre contentieuse de l'obligation alimentaire ascendante dans le financement de la dépendance des personnes âgées. Dans un premier temps, la mise en œuvre concrète de ce dispositif est étudiée à partir d'un échantillon de décisions rendues entre 2000 et 2003. La règle de mise à contribution estimée s'avère anti-redistributive à l'échelle inter-familiale mais redistributive à l'échelle intra-familiale. Dans un second temps, l'utilisation d'un échantillon représentatif des personnes âgées de 75 ans et plus et de leurs obligés alimentaires, simulé à l'aide du model DESTINIE, permet d'étudier les effets distributifs de la règle de mise à contribution mise à jour.This paper seeks to analyze economic transfers relating to the financing of long-term care for the elderly, as they arise from court decisions on the legal duty to financially support ascendants. The first section reviews the computation of the support obligation based on a sample of courtdecisions between2000 and 2003. The financial contribution ruleestimated from the decisions is found to be anti-redistributive in interfamily distribution terms but redistributive in intrafamily distribution terms. The second section uses the DESTINIE model to simulate a representative sample of persons aged 75 or older and those legally responsible for their financial support, and uses the sample to examine the distributive effects of the financial contribution rule.Long-term care; Obligation alimentaire; Microsimulation; Inégalités;