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Dépenses de santé : l'hypothèse d'aléa moral

Listed author(s):
  • Pierre-Yves Geoffard

[eng] Health Expenditures : the Moral Hazard Assumption by Pierre- Yves Geoffard The analysis of many proposals to reform the French health insurance system, and in particular those focusing on co-payment schemes, is heavily dependent on delicate empirical measures of the elasticity of demand for health care. This paper offers a critical survey of the empirical literature on the moral hazard assumption, according to which more extensive health insurance coverage would lead to more spending. The paper begins by recalling that the Rand Health Insurance Study, a major study conducted in the United States in the 1970s, unambiguously concluded that the price elasticity of demand for medical care was negative, especially for ambulatory care. The paper then stresses the limitations of more recent studies undertaken on French data - limitations which are either inherent to the data or due to the econometric methods employed. In addition, evaluating the redistributive aspects of co-payments and their impact on access to care would require more accurate measures of cross price-income elasticity. Despite all these uncertainties, the lessons drawn from the existing empirical studies suggest that the current French co-payment scheme (the ticket modérateur system) is very far from being fair and efficient. [fre] L'analyse de nombreuses propositions de réforme du système d'assurance maladie, notamment celles visant à modifier le ticket modérateur, repose fortement, in fine, sur de délicates mesures empiriques des élasticités des fonctions de demande de soins. Cet article propose un panorama critique de la littérature empirique, récente ou plus ancienne, consacrée à l'hypothèse d'aléa moral, selon laquelle une couverture maladie plus complète conduirait à davantage de dépenses. Après avoir rappelé que la grande étude de la RAND, réalisée aux États-Unis dans les années 70, avait conclu sans ambiguïté à une élasticité prix négative de la demande de soins, notamment ambulatoires, l'article insiste sur les limites des études réalisées sur données françaises, limites liées tant aux données disponibles qu'aux méthodes économétriques employées. En outre, afin d'examiner les effets redistributifs du ticket modérateur, ainsi que son impact sur l'accès aux soins, des mesures d'élasticité croisée prix revenu seraient nécessaires. Malgré toutes ces incertitudes et ces réserves, les leçons tirées des analyses empiriques laissent croire que le dispositif actuel de ticket modérateur est très éloigné d'un mécanisme juste et efficace.

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

Volume (Year): 142 (2000)
Issue (Month): 1 ()
Pages: 123-135

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Handle: RePEc:prs:ecoprv:ecop_0249-4744_2000_num_142_1_5992
Note: DOI:10.3406/ecop.2000.5992
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