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Comportements opportunistes des patients et des médecins : l'apport d'analyses par épisode de soins

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  • Pascale Breuil-Genier
  • Frédéric Rupprecht

Abstract

[eng] Opportunistic Behaviour of Patients and Doctors: the Contribution of Analyses by Health Care Episode by Pascale Breuil-Genier and Frédéric Rupprecht . The "strategic" behaviours attributed to patients (adverse selection, moral hazard) and health care professionals (supply-induced demand) are not easily tested: although it is easy to find a link between health insurance and health care consumption, it is more difficult to single out the behavioural consequences of moral hazard and adverse selection. Similarly, a simultaneous increase in doctor density and in health care consumption may indeed be a consequence of induced demand (whereby doctors create the demand for their own services), but it may also result from an exogenous rise in health care needs combined with a simultaneous rise in the resources required to meet them. In an attempt to identify the determinants of patients' and doctors' behaviour more precisely, we analyse the series of consumption decisions taken for a given illness and a given patient by reconstructing health care episodes from the 1 99 1 -92 health survey. Our analysis shows that a patient' s decision to seek health care in case of sickness is strongly influenced by whether the patient possesses supplementary insurance coverage, but that this factor has no impact on the choice of the type of first consultation (general practitioner or specialist), nor on whether the patient subsequently seeks other consultations. The doctor density explains part of the choice between general practitioners and specialists for the initial consultation, but this variable has no impact on the number of first consultations, nor on whether the patient subsequently seeks other consultations. [fre] Les comportements " stratégiques " prêtés aux patients (anti-sélection, aléa moral) comme aux professionnels du système de soins (demande induite) sont difficilement testables. En effet, s'il est aisé de trouver un lien entre assurance et consommation de soins, il est plus délicat de faire la part des choses entre ce qui résulte de comportements d'aléa moral ou d' anti-sélection. De même, une augmentation parallèle de la densité médicale et de la consommation de soins peut certes traduire des phénomènes de demande induite (les médecins créent leur propre demande) mais peut aussi être la conséquence d'une hausse exogène des besoins de soins accompagnée d'une augmentation parallèle des moyens nécessaires à les satisfaire. Pour essayer de cerner plus précisément les déterminants des comportements des patients et des médecins, nous analysons ici la succession des décisions de consommation pour une maladie et un patient donnés en reconstruisant des épisodes de soins à partir de l'enquête santé 1991-92. On montre ainsi que la possession d'une assurance complémentaire a une incidence forte sur la décision de recourir aux soins en cas de maladie, mais qu'elle n'en a plus sur le choix du type de premier recours (généraliste ou spécialiste) ou sur l'existence de recours ultérieurs. Si la densité médicale peut expliquer une partie du choix entre généraliste et spécialiste en premier recours, elle est sans incidence sur le nombre de premiers recours ou l'existence de recours ultérieurs.

Suggested Citation

  • Pascale Breuil-Genier & Frédéric Rupprecht, 2000. "Comportements opportunistes des patients et des médecins : l'apport d'analyses par épisode de soins," Économie et Prévision, Programme National Persée, vol. 142(1), pages 163-181.
  • Handle: RePEc:prs:ecoprv:ecop_0249-4744_2000_num_142_1_5994
    Note: DOI:10.3406/ecop.2000.5994
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