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Les différences d'état de santé en France : inégalités des chances ou reflet des comportements à risques ?

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  • Jusot, Florence
  • Tubeuf, Sandy
  • Trannoy, Alain

Abstract

Deux méthodes sont généralement envisagées pour l'évaluation des politiques de santé. L'approche coût-bénéfice s'appuie sur la somme des consentements individuels à payer : elle respecte les préférences individuelles mais elle donne une priorité aux préférences des plus riches car leurs consentements à payer sont en général plus élevés. L'approche coût-efficacité sélectionne les politiques assurant le gain le plus élevé en matière de santé globale, à coût total donné. Elle n'avantage pas les individus à revenu élevé, mais elle peut avoir d'autres effets indésirables : par exemple favoriser le traitement d'une affection bénigne qui profitera au plus grand nombre par rapport à une affection grave touchant peu de personnes. Une variante de l'analyse coût-bénéfice évite ces différents écueils. Elle consiste à pondérer les consentements à payer par des coefficients qui varient en sens inverse d'un indicateur de bien-être individuel combinant revenu et état de santé. L'indicateur choisi est le revenu équivalent santé : il s'agit du revenu effectif de l'individu diminué du montant auquel il serait prêt à renoncer pour être en parfaite santé. À revenu donné, il décroit donc quand la santé se détériore. Contrairement à des indices d'utilité subjective, il a l'avantage de ne s'appuyer que sur les préférences ordinales des individus. Cette approche est mise en œuvre à l'aide d'une enquête conduite sur un échantillon représentatif de la population française. Compte tenu de leurs contraintes financières, les personnes à bas revenu accordent moins d'importance relative à leur état de santé. Mais les coefficients obtenus permettent néanmoins de surpondérer les individus les moins favorisés cumulant faible revenu, mauvaise santé et forte préférence pour l'amélioration de cette santé. Ces coefficients sont ensuite mobilisables pour l'évaluation de toute politique pour laquelle on connaitrait les consentements individuels à payer.

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Bibliographic Info

Paper provided by Paris Dauphine University in its series Economics Papers from University Paris Dauphine with number 123456789/11292.

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Date of creation: May 2013
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Publication status: Published in Economie et statistique, 2013, no. 455-456. pp. 37-51.Length: 14 pages
Handle: RePEc:dau:papers:123456789/11292

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Web page: http://www.dauphine.fr/en/welcome.html
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Keywords: Santé publique; Économie de la santé; Politiques publiques;

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