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Induction de la demande de soins par les médecins libéraux français. Étude micro-économétrique sur données de panel

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  • Brigitte Dormont
  • Éric Delattre

Abstract

[fre] Cette étude a pour objet d'analyser les comportements d'offre de soins des médecins libéraux français. On dispose pour cela d'un panel non cylindre de 7 925 médecins omnipraticiens ou spécialistes, des secteurs 1 ou 2, suivis sur la période 1979-1993 et représentatif de la population concernée. Les estimations mettent en évidence l'existence de comportements de demande induite indéniables dans le secteur 1 . Ces comportements permettent aux médecins de limiter les rationnements qu'ils subissent sur le nombre de rencontres médecin-patient quand la densité médicale augmente, et de les compenser par une augmentation du volume de soins fournis au cours de chaque rencontre. Dans le secteur 2 (à honoraires libres), la réaction des médecins aux variations de la densité est compatible avec une absence de comportements d'induction. En effet, une élévation de la densité médicale conduit dans ce secteur à une baisse des tarifs et à une augmentation de l'activité, réactions conformes aux prédictions d'un modèle d'offre de soins basé sur l'hypothèse de concurrence monopolistique. Au total, on constate qu'une augmentation de la densité entraîne une hausse des quantités de soins fournies dans les deux secteurs. En outre, les baisses de tarifs observées dans le secteur 2 ne contribuent pas à un rééquilibrage des comptes sociaux, puisqu'elles ne concernent que les dépassements. Enfin, nos évaluations permettent d'établir que les élasticités estimées au niveau microéconomique correspondent, au niveau macroéconomique, à une forte dérive de la consommation de soins en liaison avec l'augmentation du nombre de médecins. [eng] Health Care Demand Induced by French Self-Employed Doctors. A Microeconometric Study Based on Panel Data by Eric Delattre et Brigitte Dormont . A much-debated hypothesis in health economics is the supply-induced demand hypothesis (SID), which posits that suppliers can manipulate demand for their services. This article tests for the existence of SID behaviour using unbalanced panel data covering 7,925 French self-employed Sector 1 and Sector 2 GPs and specialised doctors from 1979 to 1993. These data are representative of the population in question. Estimates provide strong evidence of SID behaviour in Sector 1. Such behaviour entails self-employed doctors restricting the rationing in the number of doctor-patient consultations to which they are subject when doctor density increases and offsetting this phenomenon by raising the volume of care provided per consultation. In Sector 2 (where doctors freely set their fees), doctors' reactions to density variations are compatible with the absence of SID behaviour. An increase in doctor density in Sector 2 brings about a drop in fees and an increase in activity. These reactions are consistent with the predictions of a monopolistic competition model of health care supply. To conclude, we find that a rise in doctor density brings about a rise in the volume of health care supplied in both Sector 1 and Sector 2. In addition, the fee reductions observed in Sector 2 do not help balance the social security system accounts, since these reductions only concern surcharges. Lastly, we establish that our estimated microeconomic elasticities create a massive macroeconomic drift in health care consumption, related to the increase in the number of doctors.

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Bibliographic Info

Article provided by Programme National Persée in its journal Économie & prévision.

Volume (Year): 142 (2000)
Issue (Month): 1 ()
Pages: 137-161

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Handle: RePEc:prs:ecoprv:ecop_0249-4744_2000_num_142_1_5993

Note: DOI:10.3406/ecop.2000.5993
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Web page: http://www.persee.fr/web/revues/home/prescript/revue/ecop

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  1. Asher Wolinsky, 1991. "Competition in a Market for Informed Experts' Services," Discussion Papers, Northwestern University, Center for Mathematical Studies in Economics and Management Science 959, Northwestern University, Center for Mathematical Studies in Economics and Management Science.
  2. Arellano, Manuel & Bond, Stephen, 1991. "Some Tests of Specification for Panel Data: Monte Carlo Evidence and an Application to Employment Equations," Review of Economic Studies, Wiley Blackwell, Wiley Blackwell, vol. 58(2), pages 277-97, April.
  3. Dranove, David, 1988. "Demand Inducement and the Physician/Patient Relationship," Economic Inquiry, Western Economic Association International, Western Economic Association International, vol. 26(2), pages 281-98, April.
  4. Carrere, Marie-Odile, 1991. "The reaction of private physicians to price deregulation in France," Social Science & Medicine, Elsevier, Elsevier, vol. 33(11), pages 1221-1228, January.
  5. Louis F. Rossiter & Gail R. Wilensky, 1984. "Identification of Physician-Induced Demand," Journal of Human Resources, University of Wisconsin Press, vol. 19(2), pages 231-244.
  6. Rochaix, Lise, 1989. "Information asymmetry and search in the market for physicians' services," Journal of Health Economics, Elsevier, Elsevier, vol. 8(1), pages 53-84, March.
  7. Victor R. Fuchs, 1978. "The Supply of Surgeons and the Demand for Operations," NBER Working Papers 0236, National Bureau of Economic Research, Inc.
  8. Reinhardt, U, 1972. "A Product Function for Physician Services," The Review of Economics and Statistics, MIT Press, vol. 54(1), pages 55-66, February.
  9. Stéphane Jacobzone & Lise Rochaix, 1997. "L'hypothèse de demande induite : un bilan économique," Économie et Prévision, Programme National Persée, Programme National Persée, vol. 129(3), pages 25-36.
  10. Valérie Paris & Pierre-Jean Lancry, 1997. "Âge, temps et normes : une analyse de la prescription pharmaceutique," Économie et Prévision, Programme National Persée, Programme National Persée, vol. 129(3), pages 173-187.
  11. Frédéric Rupprecht & Alain Quinet & Yannick L'Horty, 1997. "Expliquer la croissance des dépenses de santé : le rôle du niveau de vie et du progrès technique," Économie et Prévision, Programme National Persée, Programme National Persée, vol. 129(3), pages 257-268.
  12. Phelps, Charles E., 1986. "Induced demand -- can we ever know its extent?," Journal of Health Economics, Elsevier, Elsevier, vol. 5(4), pages 355-365, December.
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Cited by:
  1. E. Delattre & B. Dormont, 2000. "Testing for supplier-induced demand behavior : A panel data study on French physicians," THEMA Working Papers 2000-42, THEMA (THéorie Economique, Modélisation et Applications), Université de Cergy-Pontoise.
  2. Sophie Béjean & Christine Peyron & Renaud Urbinelli, 2007. "Variations in activity and practice patterns: a French study for GPs," The European Journal of Health Economics, Springer, Springer, vol. 8(3), pages 225-236, September.

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