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Quelle régulation pour les hôpitaux publics français ?

Author

Listed:
  • Brigitte Dormont

    (LEDa - Laboratoire d'Economie de Dauphine - IRD - Institut de Recherche pour le Développement - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres - CNRS - Centre National de la Recherche Scientifique, Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres)

  • Carine Milcent

    (PJSE - Paris-Jourdan Sciences Economiques - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique)

Abstract
[eng] The purpose of this paper is to study hospital costs in the event of introduction of a Prospective Payment System in France. We use a nested three dimensional database (stays- hospitals-years) in order to identify hospital unobservable heterogeneity and a transitory moral hazard component of cost variability. Econometric estimate are performed on a sample of 7,314 stays for acute myo-cardial infarction observed in 36 French public hospitals over the period 1994 to 1997. Transitory moral hazard is far from negligible: its estimated standard error is about 50 % of the standard error we estimate for cost variability due to permanent unobervable heterogeneity between hospitals. Simulations show that a cost reduction of about 16 % can be expected from implementation of a payment system which allows for permanent unobserved heterogeneity and eliminates only transitory moral hazard. [fre] Cet article étudie les coûts des hôpitaux publics français dans la perspective d'une réforme de la tarification. Nous utilisons des données à trois dimensions hôpital-séjour-année afin d'identifier l'hétérogénéité non observée des hôpitaux et la composante de la variabilité du coût attribuable à l'aléa moral transitoire. Les applications empiriques sont réali- sees sur un échantillon de 7 314 séjours pour infarctus du myocarde aigu observés dans 36 hôpitaux publics français sur la période 1 994-1997. L'aléa moral transitoire est loin d'être négligeable. Son écart-type estimé s'élève à 50 % de la variabilité des coûts due à l'hétérogénéité non observée des hôpitaux. Les simulations montrent que l'on peut attendre des économies budgétaires de 16 % environ de l'application d'une tarification qui prend en compte les hétérogénéités observées entre les hôpitaux et n'élimine que l'aléa moral transitoire.
(This abstract was borrowed from another version of this item.)

Suggested Citation

  • Brigitte Dormont & Carine Milcent, 2002. "Quelle régulation pour les hôpitaux publics français ?," Post-Print halshs-01990530, HAL.
  • Handle: RePEc:hal:journl:halshs-01990530
    DOI: 10.3406/rfeco.2002.1463
    Note: View the original document on HAL open archive server: https://shs.hal.science/halshs-01990530
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    References listed on IDEAS

    as
    1. Ma, Ching-to Albert, 1994. "Health Care Payment Systems: Cost and Quality Incentives," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 3(1), pages 93-112, Spring.
    2. Emmanuelle Auriol & Jean‐Jacques Laffont, 1992. "Regulation By Duopoly," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 1(3), pages 507-533, September.
    3. Ching‐to Albert Ma, 1998. "Health‐Care Payment Systems: Cost and Quality Incentives—Reply," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 7(1), pages 139-142, March.
    4. Mark McClellan, 1997. "Hospital Reimbursement Incentives: An Empirical Analysis," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 6(1), pages 91-128, March.
    5. Jean-Jacques Laffont & Jean Tirole, 1993. "A Theory of Incentives in Procurement and Regulation," MIT Press Books, The MIT Press, edition 1, volume 1, number 0262121743, April.
    6. Ellis, Randall P., 1998. "Creaming, skimping and dumping: provider competition on the intensive and extensive margins1," Journal of Health Economics, Elsevier, vol. 17(5), pages 537-555, October.
    7. Guillem López‐Casasnovas & Marc Saez, 1999. "The impact of teaching status on average costs in Spanish hospitals," Health Economics, John Wiley & Sons, Ltd., vol. 8(7), pages 641-651, November.
    8. repec:bla:jemstr:v:3:y:1994:i:1:p:93-112:a is not listed on IDEAS
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    Cited by:

    1. Laurent Gobillon & Carine Milcent, 2013. "Spatial disparities in hospital performance," Journal of Economic Geography, Oxford University Press, vol. 13(6), pages 1013-1040, November.
    2. Laurent Gobillon & Carine Milcent, 2016. "Evaluating the Effect of Ownership Status on Hospital Quality: The Key Role of Innovative Procedures," Annals of Economics and Statistics, GENES, issue 121-122, pages 161-186.
    3. Biorn, Erik & Hagen, Terje P. & Iversen, Tor & Magnussen, Jon, 2006. "Heterogeneity in Hospitals' Responses to a Financial Reform: A Random Coefficient Analysis of The Impact of Activity-Based Financing on Efficiency," MPRA Paper 8169, University Library of Munich, Germany.
    4. Laurent Gobillon & Carine Milcent, 2008. "Regional disparities in mortality by heart attack: evidence from France," Working Papers halshs-00586837, HAL.

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