IDEAS home Printed from https://ideas.repec.org/p/del/abcdef/2004-11.html
   My bibliography  Save this paper

Innovation diffusion under budget constraints - Microeconometric evidence on heart attack in France -

Author

Listed:
  • Brigitte Dormont
  • Carine Milcent

Abstract

This paper studies the relationship between the diffusion of innovative procedures for the treatment of heart attack and the distributions of the cost and length of hospital stays. Using a sample of 5,681 stays observed in French publics hospitals, we use micro-simulation techniques in order to highlight various effects on the shifts in the overall distributions of the costs and length of stays: (i) the effect of the adoption of new techniques by hospitals (between hospital diffusion); (ii) the effect of the diffusion of technological progress within hospitals; (iii) the effect of the evolutions of patients characteristics (age x gender, co-morbidities). This decomposition approach is used in the literature relative to the relationship between education and income distribution where observed distributions are compared to counterfactual distributions built by replacing some estimated parameters with their counterparts estimated from another country or period. Our results show that between 1994 and 1997 hospitals faced two main causes of rises in costs: on the one hand, diffusion of technological progress, with increasing use of costly innovative procedures such as angioplasty; on the other hand, patients' epidemiological state worsened, since they became older and had more secondary diagnoses. These two factors induced sizeable shocks in cost distributions. During the same period, French public hospitals were financed by a global budget, and their budgets increased very slowly. International comparisons show that diffusion of technological progress for AMI treatment is similar in France and in comparable countries. How did French hospitals deal with their financial constraints? Our results show that they sharply reduced the length of stays for patients at the bottom of the distribution. This reduction in the length of stays appears to have been a condition for the diffusion of angioplasty. Obviously, such a condition cannot be sustained in the long run without jeopardizing quality of care.

Suggested Citation

  • Brigitte Dormont & Carine Milcent, 2004. "Innovation diffusion under budget constraints - Microeconometric evidence on heart attack in France -," DELTA Working Papers 2004-11, DELTA (Ecole normale supérieure).
    • Handle: RePEc:del:abcdef:2004-11
    as

    Download full text from publisher

    File URL: http://www.delta.ens.fr/abstracts/wp200411.pdf
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. F. Bourguignon & M. Fournier & M. Gurgand, 2001. "Fast Development With a Stable Income Distribution: Taiwan, 1979–94," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 47(2), pages 139-163, June.
    2. Bourguignon, Francois & Fournier, M & Gurgand, M, 2001. "Fast Development with a Stable Income Distribution: Taiwan, 1979-94," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 47(2), pages 139-163, June.
    3. Van de Ven, Wynand P. M. M. & Van Praag, Bernard M. S., 1981. "The demand for deductibles in private health insurance : A probit model with sample selection," Journal of Econometrics, Elsevier, vol. 17(2), pages 229-252, November.
    4. Juhn, Chinhui & Murphy, Kevin M & Pierce, Brooks, 1993. "Wage Inequality and the Rise in Returns to Skill," Journal of Political Economy, University of Chicago Press, vol. 101(3), pages 410-442, June.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Laurent Gobillon & Carine Milcent, 2013. "Spatial disparities in hospital performance," Journal of Economic Geography, Oxford University Press, vol. 13(6), pages 1013-1040, November.
    2. Carine Milcent, 2021. "Competition in French hospital: Does it impact the patient management in healthcare?," Working Papers halshs-03152752, HAL.
    3. Laurent Gobillon & Carine Milcent, 2008. "Regional disparities in mortality by heart attack: evidence from France," Working Papers halshs-00586837, HAL.
    4. Carine Milcent, 2021. "Competition in French hospital: Does it impact the patient management in healthcare?," Working Papers halshs-03152752, HAL.
    5. Brigitte Dormont & Michel Grignon & Hélène Huber, 2006. "Health expenditure growth: reassessing the threat of ageing," Health Economics, John Wiley & Sons, Ltd., vol. 15(9), pages 947-963, September.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Ebo Botchway & Kofi Fred Asiedu, 2020. "Ownership type and earnings gap decomposition: Evidence from the Ghanaian labor market," African Development Review, African Development Bank, vol. 32(4), pages 619-631, December.
    2. Utpal Kumar De & Loitongbam Hena Devi, 2023. "Inequality Dynamics in Urban Manipur, India: A Decomposition Analysis," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 167(1), pages 67-89, June.
    3. Mulubrhan Amare & Bekele Shiferaw & Hiroyuki Takeshima & George Mavrotas, 2021. "Variability in agricultural productivity and rural household consumption inequality: Evidence from Nigeria and Uganda," Agricultural Economics, International Association of Agricultural Economists, vol. 52(1), pages 19-36, January.
    4. Bourguignon, Francois, 2005. "The Effect of Economic Growth on Social Structures," Handbook of Economic Growth, in: Philippe Aghion & Steven Durlauf (ed.), Handbook of Economic Growth, edition 1, volume 1, chapter 27, pages 1701-1747, Elsevier.
    5. Cathal O’Donoghue & Denisa M Sologon & Iryna Kyzyma & John McHale, 2021. "A Microsimulation Analysis of the Distributional Impact over the Three Waves of the COVID-19 Crisis in Ireland," International Journal of Microsimulation, International Microsimulation Association, vol. 14(2), pages 81-105.
    6. Ferreira , Francisco H. G., 2010. "Distributions in motion: economic growth, inequality, and poverty dynamics," Policy Research Working Paper Series 5424, The World Bank.
    7. Maurizio Bussolo & Rafael E De Hoyos & Denis Medvedev, 2010. "Economic growth and income distribution: linking macro-economic models with household survey data at the global level," International Journal of Microsimulation, International Microsimulation Association, vol. 3(1), pages 92-103.
    8. O'Donoghue, Cathal & Sologon, Denisa Maria, 2023. "The Transformation of Public Policy Analysis in Times of Crisis – A Microsimulation-Nowcasting Method Using Big Data," IZA Discussion Papers 15937, Institute of Labor Economics (IZA).
    9. Keogh-Brown, Marcus & McDonald, Scott & Edmunds, W. John & Beutels, Philippe & Smith, Richard D., 2008. "The macroeconomic costs of a global influenza pandemic," Conference papers 331699, Purdue University, Center for Global Trade Analysis, Global Trade Analysis Project.
    10. Camara, Alhassane & Savard, Luc, 2023. "Impact of agricultural input subsidy policy on market participation and income distribution in Africa: A bottom-up/top-down approach," Economic Modelling, Elsevier, vol. 129(C).
    11. Martin FOURNIER, 2001. "Inequality decomposition by factor component : a “rank-correlation” approach illustrated on the Taiwanese case," Discussion Papers (REL - Recherches Economiques de Louvain) 2001042, Université catholique de Louvain, Institut de Recherches Economiques et Sociales (IRES).
    12. Ramani Gunatilaka & Duangkamon Chotikapanich, 2009. "Accounting For Sri Lanka'S Expenditure Inequality 1980–2002: Regression‐Based Decomposition Approaches," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 55(4), pages 882-906, December.
    13. Alaba, Olumuyiwa, 2006. "EU-ECOWAS EPA: Regional Integration, Trade Facilitation and Development in West Africa," Conference papers 331477, Purdue University, Center for Global Trade Analysis, Global Trade Analysis Project.
    14. Guillermo Alves & Verónica Amarante & Gonzalo Salas & Andrea Vigorito, 2012. "La desigualdad del ingreso en Uruguay entre 1986 y 2009," Documentos de Trabajo (working papers) 12-03, Instituto de Economía - IECON.
    15. Guanghua Wan & Zhangyue Zhou, 2005. "Income Inequality in Rural China: Regression‐based Decomposition Using Household Data," Review of Development Economics, Wiley Blackwell, vol. 9(1), pages 107-120, February.
    16. Bouët, Antoine & Estrades, Carmen & Laborde, David, 2012. "Cooperation vs. non cooperation in the multilateral trading system: the impact on poverty and inequality in developing countries," Conference papers 332287, Purdue University, Center for Global Trade Analysis, Global Trade Analysis Project.
    17. Francesco Devicienti, 2010. "Shapley-value decompositions of changes in wage distributions: a note," The Journal of Economic Inequality, Springer;Society for the Study of Economic Inequality, vol. 8(1), pages 35-45, March.
    18. FANG Zheng & Chris SAKELLARIOU, 2010. "After the Reforms: Determinants of Wage Growth and Change in Wage Inequality in Vietnam - 1998 -2008," Economic Growth Centre Working Paper Series 1006, Nanyang Technological University, School of Social Sciences, Economic Growth Centre.
    19. Ragayah Haji Mat Zin, 2005. "Income Distribution in East Asian Developing Countries: recent trends," Asian-Pacific Economic Literature, The Crawford School, The Australian National University, vol. 19(2), pages 36-54, November.
    20. Brocker, Johannes, 2005. "Necessary and unnecessary parameter restrictions for CDES demand systems," Conference papers 331358, Purdue University, Center for Global Trade Analysis, Global Trade Analysis Project.

    More about this item

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:del:abcdef:2004-11. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: the person in charge (email available below). General contact details of provider: https://edirc.repec.org/data/deltafr.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.