Aging, Health and Aggregate Medical Care Spending in France

I investigate the role of education on health, using country level data and the production frontier framework suggested by the World Health Organization to assess performances of health care systems. I find that the role of human capital is much smaller than what appears in the WHO frontier model, and the relationship exhibits diminishing return in the observed range. Taking into account the non-linearity in this relationship generates a different ranking of countries according to the efficiency of their health care system. This suggests that the method currently used by the WHO indeed favours health care systems operating in countries which underinvested in education in the past. The relationship between education and health changes around an average value of 8 years of education per individual: above that level, the return of years of education in health is zero.Human capital, Rate of return, Economic impact, Efficiency

Sickness and injury leave in France: moral hazard or strain?

From 1997 to 2001, the total payment to compensate for sickness and injury leaves increased dramatically in France. Since this change coincided with a decrease in unemployment rate,three hypothesizes should be proposed as possible explanations consistently with the literature: moral hazard (workers fear less to loose their job, therefore use sickness leave more confidently); strain (workers work longer hours or under more stringent rules); labor-force composition effect (less healthy individuals are incorporated into the labor force). We investigate the first two strands of explanation using a household survey (ESPS) enriched with claims data from compulsory health insurance funds on sickness leaves (EPAS). We model separately number of leaves per individual (cumulative logit) and duration of leaves (random-effect model). According to our findings, in France, the individual propensity to take sickness leave is mainly influenced by strain in the workplace and by a labor-force composition effect. Conditional duration of spells is not well explained at the individual level: the only significant factor is usual weekly work duration. Influence of moral hazard is not clearly ascertained: it has few impact on occurrences of leave and no impact on duration.Sickness, Labour Force

The Value of Fixed-Reimbursement Healthcare Insurance- Evidence from Cancer Patients in Ontario, Canada

Critical illness insurance (CII) is a fixed-reimbursement scheme conditioned on the event of a loss, not the size of the loss. We investigate demand for CII. Consumers will be willing to purchase CII depending on their degree of risk aversion to the cost of treating illness, their forgone income, and desire for being compensated for utility loss when sick. Using a theoretical model based on Eeckhoudt (2003), we run simulations using Canadian data for CII policy reimbursement dollar values of purchases, family income, cancer expenditure, and net wealth. We then evaluate how well these models predict actual CII purchases.health insurance, healthcare insurance, fixed-reimbursement insurance, state-utility transfer, expected utility, cancer

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

Psychosocial resources and social health inequalities in France: Exploratory findings from a general population survey

We study the psychosocial determinants of self-assessed health in order to explain social inequalities in health in France. We use a unique general population survey to assess the respective impact on self-assessed health status of subjective perceptions of social capital, social support, and sense of control, controlling for standard socio-demographic factors (SES, income, education, age and gender). The survey is unique in that it provides a variety of measures of self-perceived psychosocial resources (trust and civic engagement, social support, sense of control, and self-esteem. We find empirical support for the link between the subjective perception of psychosocial resources and health. Sense of control at work is the most important correlate of health status after income. Other important ones are civic engagement and social support. To a lesser extent, sense of being lower in the social hierarchy is associated with poorer health status. On the contrary, relative deprivation does not affect health in our survey. Since access to psychosocial resources is not equally distributed in the population, these findings suggest that psychosocial factors can partially explain of social inequalities in health in France.social capital, social support, relative deprivation, sense of control, social health inequalities, France

Psychosocial resources and social health inequalities in France: Exploratory findings from a general population survey

We study the psychosocial determinants of health, and their impact on social inequalities in health in France. We use a unique general population survey to assess the respective impact on selfassessed health status of subjective perceptions of social capital controlling for standard socio-demographic factors (occupation, income, education, age and gender). The survey is unique for two reasons: First, we use a variety of measures to describe self-perceived social capital (trust and civic engagement, social support, sense of control, and selfesteem). Second, we can link these measures of social capital to a wealth of descriptors of health status and behaviours. We find empirical support for the link between the subjective perception of social capital and health. Sense of control at work is the most important determinant of health status. Other important ones are civic engagement and social support. To a lesser extent, sense of being lower in the social hierarchy is associated with poorer health status. On the contrary, relative deprivation does not affect health in our survey. Since access to social capital is not equally distributed in the population, these findings suggest that psychosocial factors can explain a substantial part of social inequalities in health in France.social capital, social support, relative deprivation, sense of control, social health inequalities, France

Health expenditure growth : reassessing the threat of ageing

In this paper we evaluate the respective effects of demographic change, changes in morbidity and changes in practices on growth in health care expenditures. We use microdata, i.e. representative samples of 3441 and 5003 French individuals observed in 1992 and 2000. Our data provide detailed information about morbidity and allow us to observe three components of expenditures: ambulatory care, pharmaceutical and hospital expenditures.We propose an original microsimulation method to identify the components of the drift observed between 1992 and 2000 in the health expenditure age profile. On the one hand, we find empirical evidence of health improvement at a given age: changes in morbidity induce a downward drift of the profile. On the other hand, the drift due to changes in practices is upward and sizeable. Detailed analysis attributes most of this drift to technological innovation.After applying our results at the macroeconomic level, we find that the rise in health care expenditures due to ageing is relatively small. The impact of changes in practices is 3.8 times larger. Furthermore, changes in morbidity induce savings which more than offset the increase in spending due to population ageing.ageing ; health expenditure ; microsimulations ; econometrics

Is There an Age Pattern in the Treatment of AMI? Evidence from Ontario

In this article we analyse the rates at which those admitted to hospital with acute myocardial infarction (AMI) receive aggressive treatment, assess how those rates have changed over time, and ask whether there is evidence of age discrepancies. Estimates made on the basis of data from an administrative database that includes discharges from all acute care hospitals in Ontario for selected years, from 1995 to 2005, indicate that there are strong and persistent age patterns in the application of medical technology. Results showed that to be true even after controlling for the higher rates of co-morbidities among older patients and variations across hospitals in practice patterns.treatment of AMI, age pattern

Is There an Age Pattern in the Treatment of AMI? Evidence from Ontario

In this article we analyse the rates at which those admitted to hospital with acute myocardial infarction (AMI) receive aggressive treatment, assess how those rates have changed over time, and ask whether there is evidence of age discrepancies. Estimates made on the basis of data from an administrative database that includes discharges from all acute care hospitals in Ontario for selected years, from 1995 to 2005, indicate that there are strong and persistent age patterns in the application of medical technology. Results showed that to be true even after controlling for the higher rates of co-morbidities among older patients and variations across hospitals in practice patterns.treatment of AMI, age pattern

Geographic Equity in Hospital Utilization: Canadian Evidence Using a Concentration-Index Approach

Distance-related geographic barriers challenge the ability of health systems to allocate health care resources equitably according to need. The paper adapts the concentration-index approach, commonly used for measuring income-related equity, to assess distance-related equity in hospital utilization in the province of Ontario, Canada. The analysis is based on individual-level data from the Canadian Community Health Survey, which provides information on respondents’ hospital utilization, health status, demographic, socio-economic status and location, merged with data on Ontario hospitals, and a geo-coded measure of each respondent’s distance to the nearest general acute-care hospital. We find no evidence of a relationship between distance to the nearest hospital and either the probability of hospitalization or the annual number of hospital nights. Supplementary analyses provide insight into hypothesized pathways between distance and hospitalization. Although having a regular medical doctor is positively associated with distance to the nearest hospital, controlling for this does not affect the estimated distance-hospitalization relationship. Both the size and occupancy rate of the nearest hospital are correlated with distance and are strongly related to the probability of hospitalization, but again controlling for these factors did not affect the estimated relationship between hospital use and distance to the nearest hospital. We do, however, find a strong positive gradient between the probability of hospitalization and distance to the nearest large hospital. This gradient is driven by the fact that, for most of those far from a large hospital, the nearest hospital is small with a low occupancy rate. Calculation of the distance-related horizontal inequity index confirms no distance-related inequity in hospital utilization when distance is measured to the nearest hospital of any size; however, when distance is instead measured to the nearest large hospital, we observe large, pro-distance inequity. These distance-use relationships are not captured by traditional geographic measures based on measures of urbanization/ruralness.hospital utilization, equity, geography