[Economic evaluation of health networks: why and how?]. / L'évaluation médico-économique des réseaux : pourquoi et comment ?

Although economic evaluation of health networks is part of the legal obligations that have to be met since March 2007, its contours still have to be defined. The purpose of this paper is to present the reasons for and approaches to such an economic analysis. Lessons will also be drawn from two economic evaluations carried out in other areas than health networks (respectively, task delegation between health care professionals and the assessment of added value for health care technologies).

Delivering generics without regulatory incentives? Empirical evidence from French general practitioners about willingness to prescribe international non-proprietary names.

France presents a unique situation in which the take-off of a generic drug market depends, out of regulatory incentives, on whether physicians choose a prescription method (international non-proprietary names, INN) that can lead to the delivery of these drugs and on whether patients accept them. This paper is aimed at pointing out factors explaining general practitioners' (GPs') willingness to prescribe in INN through data collected from a South-Eastern France representative sample of 600 GPs in March 2002. The main results shed light on the key-role played by GPs' information about drugs and the source which they take it from, by GPs' volume of services and caseloads, and slightly by socio-economic characteristics of patients.

Equity in the finance of health care: some further international comparisons.

This paper presents further international comparisons of progressivity of health care financing systems. The paper builds on the work of Wagstaff et al. [Wagstaff, A., van Doorslaer E., et al., 1992. Equity in the finance of health care: some international comparisons, Journal of Health Economics 11, pp. 361-387] but extends it in a number of directions: we modify the methodology used there and achieve a higher degree of cross-country comparability in variable definitions; we update and extend the cross-section of countries; and we present evidence on trends in financing mixes and progressivity.

The redistributive effect of health care finance in twelve OECD countries.

The OECD countries finance their health care through a mixture of taxes, social insurance contributions, private insurance premiums and out-of-pocket payments. The various payment sources have very different implications for both vertical and horizontal equity and on redistributive effect which is a function of both. This paper presents results on the income redistribution consequences of the health care financing mixes adopted in twelve OECD countries by decomposing the overall income redistributive effect into a progressivity, horizontal inequity and reranking component. The general finding of this study is that the vertical effect is much more important than horizontal inequity and reranking in determining the overall redistributive effect but that their relative importance varies by source of payment. Public finance sources tend to have small positive redistributive effects and less differential treatment while private financing sources generally have (larger) negative redistributive effects which are to a substantial degree caused by differential treatment.

The physician as perfect agent: a comment.

This comment is focused on the nature of the agency relationship between the physician and the patient. Beyond the discussion of the relative merits of the empowered physician versus empowered patient model. it is argued here that two features need to be integrated for an adequate account of this complex interaction: the two stages of the physician's action (the diagnosis and the treatment) and the physician's double agency (to the patient and to the representative of the collective interest).

[Analysis of the health care market: which role for health economics?]. / L'analyse du marché des soins médicaux: quelle place pour l'économie de la santé?

Since the early 70s, economists have tried to analyse health insurance and health care markets. In so doing, they have brought out the special features of this field of application, which require substantial adaptation of the standard economic tool kit. In conjunction with the twentieth anniversary of the Revue d'Epidémiologie et de Santé Publique, it is timely to question the relevance of economics to health and health care, its strengths and weaknesses. Such will be the purpose of this presentation.

Financial incentives for physicians: the Quebec experience.

This paper presents an empirical investigation of physician labour supply, based on a two-stage budgeting model, drawing on an analogy with consumer theory. Physicians' trade-offs between income and leisure constitute the first stage of the decision-making process. In turn, choices are made in the second stage concerning the choice of particular activities (hospital versus office care, for example) or procedures (ordinary versus complete medical examinations), given the total medical care activity chosen in the first stage. The objective of the study is to identify physicians' responses to exogenous shocks in the remuneration system. The focus of analysis is shifted away from the identification of Supply-Induced Demand (SID) to a more pragmatic analysis of some of the determinants of physicians' choices. The study uses monthly activity data on a panel of 677 Québec GPs between 1977 and 1983. Quantity adjustments and drifts to more complex (and therefore better paid) procedures are evidenced, mainly in response to a fifteen month tariff-freeze. Physicians' ability to control their own work loads is also documented, both in terms of timing and level of complexity, and expenditure caps (in the form of an individual ceiling on GPs' quarterly gross income) are found to be effective at curbing high activity rates.

Information asymmetry and search in the market for physicians' services.

This paper offers an integrated approach to the physician-patient interaction based on the notion of a conditional demand function where the physician 'proposes' and the patient 'disposes'. The model specifies the information asymmetry between the physician and the patient mainly in terms of a differential in uncertainty about the patient's health status. An imperfect agency may result, leading some physicians to recommend more (less) treatment than the patient would have chosen, had the patient been fully informed. But patients are shown to exert pressure on their physician by potentially seeking a second opinion. In effect, patients' search for an adequate treatment becomes an ex ante monitoring technique, which induces physicians to act as 'better agents'. We further show, by means of a simulation, that it is enough for a small number of patients to be well informed for this result to hold.

For-profit hospitals for Europe: the case of Britain and France.

The paper first describes the structural characteristics of the for-profit private sector in Britain and in France. In Britain, the recent growth of the for-profit private hospital's sector, although still a small sector, is related to the growth of private insurance. Cost-containment however coupled to rapid increases in premiums is slowing down the momentum. Moreover, the NHS starts charging private hospitals for such services like blood banks. In France the private sector has always been strong, although living in a highly regulated and dependent symbiosis with the public sector. In a second part, speculations are made on the crucial question whether for-profit hospitals are a legitimate alternative for Europe. In the end, an in-between solution is opted for by which the public sector would sub-contract certain functions like data processing, management and others, from the commercial sector.