Contenu du sommaire : Avancées de la recherche en économie de la santé à l'occasion des 43es journées des économistes de la santé français (JESF)

We analyze how preferences with respect to time and risk as well as trust in others and political opinion correlate with COVID-19-related protective behavior in France. We leverage individual-level data from the Survey of Health Aging and Retirement in Europe (SHARE), linked with a drop-off questionnaire about preferences conducted in France just before the coronavirus outbreak. Our results suggest that patience and risk aversion are strong predictors of individuals' protective behavior. More patient individuals are more likely to not visit their family members anymore, wear a mask and keep their distance from others when outside, wash their hands more regularly and cover their cough. Risk aversion increases the likelihood of not meeting more than five other people and not meeting with family members anymore. Concerning trust, we find that a higher level of trust in others reduces compliance with the recommendations about meeting with five or more people and family gatherings. We interpret this result as a sign that individuals with trust in others perceive a lower risk of being infected by friends and family members. Finally, we find that although the association is not always statistically significant, individuals who identify themselves as positioned on the extreme of the political spectrum (either on the left or the right) are less likely to follow the recommendation related to gathering with five or more individuals. This latter result is particularly interesting in the French context, where the government identifies itself as centrist and more extreme political groups are its main opponents. The government should therefore consider individuals' heterogeneity in preferences and beliefs when implementing a strategy to encourage people to comply with its COVID-19 protective recommendations.

This article seeks to understand the differences in prevalences of disabilities of the old between regions: are they social, related to the financial or geographical accessibility of the medico-social supply, to territorial mobility or to other territorial factors? Data from two surveys: VQS 2014 and EHPA 2015 are pooled together to model disability through a multilevel analysis. They are combined with contextual data characterizing the regions. We find that territorial differences largely reflect social and longevity differences but that care supply also contributes to these differences.

Are inequalities of opportunities in health, which are inequalities related to social and family background, similar for men and women? Using European data and reduced form models, we measure and decompose health inequalities separately for women and men. We find that half of the total health inequality is due to inequalities of opportunities. Health inequalities are more pronounced in countries where gender inequalities are the highest. Health inequalities are higher in women. We show a gendered intergenerational transmission of health: daughters' health is mainly associated with mothers' health and sons' health with fathers' health. Furthermore, mothers' education is exclusively associated with daughters' health, while fathers' education is associated with sons' health.

In France, the national health insurance (NHI) covers the majority of health expenses, the rest being more or less covered by the complementary health insurance (CHI). But do insured persons really know their CHI contract? This empirical work explores administrative data matched with survey data providing information on usually unobserved characteristics (health status or risk aversion). First, we identify the factors that influence policyholders' knowledge of their contract, then we analyze the gap between reimbursements and contributions using quantile regressions. Paradoxically, this gap does not seem to be widened by the consumption of so-called “comfort” care but rather by hospital care. Moreover, a better knowledge of one's contract seems to be beneficial.

In France, the joint evolution of both primary care supply—with a GP shortage—and demand have led to an increasing imbalance. The trend towards horizontal and vertical integration in primary care, with the support given to the development of multi-professional primary care groups (MPCGs) or Primary Care Team (PCTs) combine with practice pay-for-coordination mechanism, aims to improve the productive efficiency. Using exact matching and difference-in-differences estimations on panel data (2013–2017 period), we find that practicing in MPCG with pay-for-coordination significantly increases general practitioners (GPs)' number of working days, patients seen and visits. Stratification tests point out that our findings especially hold for female, young and GPs practicing in medically underserved areas. Results are mainly driven by organizational design and not by pay-for-coordination schemes.

The objective of this work is to analyze the causal impact of the implementation of a vertical integration strategy of public hospitals (a.k.a. the Territorial Hospitals Group or GHT) on the diffusion of technology within French healthcare institution, using panel data from the French annual survey of hospitals and a double-difference method over the recent period (2013-2019). Our results show a double effect. On the one hand, the public sector has continued to slow down its investment, consistent with the desire to reorganize healthcare supply in the hospital group. On the other hand, a countercyclical and competitive reaction has emerged from the private sector, which has relaunched its investment strategy in health technologies.