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La réglementation hospitalière : tarification par pathologie ou achat de soins ?

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  • Michel Mougeot
  • Florence Naegelen

Abstract

[fre] La réglementation hospitalière : tarification par pathologie ou achat de soins ? par Michel Mougeot, Florence Naegelen . De nombreux pays ont mis en place des mécanismes incitatifs pour maîtriser des dépenses de santé. La tarification par pathologie repose sur une logique de concurrence par comparaison. Les quasi-marchés dans lesquels un acheteur de soins met en concurrence des offreurs reposent sur une logique d'enchère. Cet article compare les performances de ces deux modes d'organisation dans un contexte d' anti-sélection et de risque moral lorsque la quantité est fixe et la qualité observée. Les conditions de mise en œuvre des deux mécanismes sont analysées lorsqu'elles sont identiques. Il est montré que l'achat de soins par un appel d'offres avec clauses incitatives conduit à une amélioration du bien être collectif et à une baisse du coût des soins. [eng] Hospital Control: Pathology-Based Charging or Purchase of Care? by Michel Mougeot and Florence Naegelen . Many countries have introduced incentive systems in order to control health spending. Pathology-based charging rests on the logic of competition through comparison, whereas the quasi-markets in which a care purchaser invites tenders from providers are based on a bidding logic. This paper compares the performance of these two methods of organisation in a context of adverse selection and moral hazard where quantity is fixed and quality respected. The conditions for implementing the two systems are analysed when they are identical. It is demonstrated that purchase of care through an invitation to tender with incentive clauses leads to an improvement in social welfare and a drop in the cost of care.

Suggested Citation

  • Michel Mougeot & Florence Naegelen, 1997. "La réglementation hospitalière : tarification par pathologie ou achat de soins ?," Économie et Prévision, Programme National Persée, vol. 129(3), pages 207-220.
  • Handle: RePEc:prs:ecoprv:ecop_0249-4744_1997_num_129_3_5874
    Note: DOI:10.3406/ecop.1997.5874
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    References listed on IDEAS

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    1. Myerson, Roger B, 1979. "Incentive Compatibility and the Bargaining Problem," Econometrica, Econometric Society, vol. 47(1), pages 61-73, January.
    2. Keeler, Emmett B., 1990. "What proportion of hospital cost differences is justifiable?," Journal of Health Economics, Elsevier, vol. 9(3), pages 359-365, November.
    3. R. Preston McAfee & John McMillan, 1986. "Bidding for Contracts: A Principal-Agent Analysis," RAND Journal of Economics, The RAND Corporation, vol. 17(3), pages 326-338, Autumn.
    4. Ballard, Charles L & Shoven, John B & Whalley, John, 1985. "General Equilibrium Computations of the Marginal Welfare Costs of Taxes in the United States," American Economic Review, American Economic Association, vol. 75(1), pages 128-138, March.
    5. Joseph P. Newhouse, 1996. "Reimbursing Health Plans and Health Providers: Efficiency in Production versus Selection," Journal of Economic Literature, American Economic Association, vol. 34(3), pages 1236-1263, September.
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    Cited by:

    1. Lise Rochaix, 1997. "Asymétries d'information et incertitude en santé : les apports de la théorie des contrats," Économie et Prévision, Programme National Persée, vol. 129(3), pages 11-24.
    2. B. Dormont & C. Milcent, 2000. "Coûts hospitaliers et tarification par pathologie. Le cas de l'infarctus du myocarde aigu," THEMA Working Papers 2000-25, THEMA (THéorie Economique, Modélisation et Applications), Université de Cergy-Pontoise.

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