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Quelle régulation pour les hôpitaux publics français ?

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  • Brigitte Dormont
  • Carine Milcent

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.

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Bibliographic Info

Article provided by Programme National Persée in its journal Revue française d'économie.

Volume (Year): 17 (2002)
Issue (Month): 2 ()
Pages: 117-142

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Handle: RePEc:prs:rfreco:rfeco_0769-0479_2002_num_17_2_1463

Note: DOI:10.3406/rfeco.2002.1463
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Web page: http://www.persee.fr/web/revues/home/prescript/revue/rfeco

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Cited by:
  1. Laurent Gobillon & Carine Milcent, 2013. "Spatial disparities in hospital performance," PSE - Labex "OSE-Ouvrir la Science Economique" halshs-00879787, HAL.
  2. Eric, Biørn & Hagen, Terje P. & Iversen, Tor & Magnussen, Jon, 2009. "Heterogenety in hospitals responses to a financial reform: A random coefficient analysis of the impact of activity-based financing on efficiency," HERO On line Working Paper Series 2006:9, Oslo University, Health Economics Research Programme.
  3. repec:hal:wpaper:halshs-00586837 is not listed on IDEAS

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