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Intérêt social et discrimination en assurance-maladie publique

  • Dominique Bureau
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    [fre] Un service public fournissant un bien essentiel comme l'est la santé peut- il différencier ses prix ou les qualités offertes ? Pour beaucoup, ceci constituerait une rupture au principe d'éga- lité qui doit guider la gestion publique. Des pratiques discriminatoires, dans lesquelles la différenciation des prix ou celle des qualités offertes iraient au-delà de ce que peut justifier l'adaptation à la variété des attentes des patients et le reflet des coûts correspondants, tendent a fortiori à être jugées néfastes. Elles le sont effectivement s'il s'agit de faciliter la constitution de rentes, ou de rompre les subventions croisées entre classes de risque. Mais ce type de dispositif peut être bénéfique, s'il constitue un moyen d'élargir l'accès aux soins ou d'en favoriser la qualité. L'évaluation du rôle du secteur privé dans l'hôpital public, ou du secteur II en médecine de ville ne doit donc pas être trop hâtive, même si les conditions pour porter un jugement favorable ne semblent pas réunies à présent. [eng] Can a public service which provides an essential good such as health care services differentiate its prices or its quality range ? For many people, such practices would constitute a breach of egalitarian principles which should guide public policies. Hence, discriminatory practices exceeding what could be justified by differences in the patients expectations or by the cost structure are generally a fortiori prohibited. This is undoubtly a sound approach when discrimination would only be a means to ease rents constitution or to break up cross subsidies bet- ween risk classes. However discrimination can also be favourable when it allows a wider access to thealth care or an improvement of services quality. This possibility must be taken into account when assessing the role of the « private sector » in French public hospitals, or of the sector II in ambulatory services, even if their present organization is unsatisfactory.

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    Article provided by Programme National Persée in its journal Revue française d'économie.

    Volume (Year): 14 (1999)
    Issue (Month): 2 ()
    Pages: 163-187

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    Handle: RePEc:prs:rfreco:rfeco_0769-0479_1999_num_14_2_1082
    Note: DOI:10.3406/rfeco.1999.1082
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