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Quelle régulation pour les hôpitaux publics français ?

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  • Brigitte Dormont
  • Carine Milcent

Abstract

[eng] The purpose of this paper is to study hospital costs in the event of introduction of a Prospective Payment System in France. We use a nested three dimensional database (stays- hospitals-years) in order to identify hospital unobservable heterogeneity and a transitory moral hazard component of cost variability. Econometric estimate are performed on a sample of 7,314 stays for acute myo-cardial infarction observed in 36 French public hospitals over the period 1994 to 1997. Transitory moral hazard is far from negligible: its estimated standard error is about 50 % of the standard error we estimate for cost variability due to permanent unobervable heterogeneity between hospitals. Simulations show that a cost reduction of about 16 % can be expected from implementation of a payment system which allows for permanent unobserved heterogeneity and eliminates only transitory moral hazard. [fre] Cet article étudie les coûts des hôpitaux publics français dans la perspective d'une réforme de la tarification. Nous utilisons des données à trois dimensions hôpital-séjour-année afin d'identifier l'hétérogénéité non observée des hôpitaux et la composante de la variabilité du coût attribuable à l'aléa moral transitoire. Les applications empiriques sont réali- sees sur un échantillon de 7 314 séjours pour infarctus du myocarde aigu observés dans 36 hôpitaux publics français sur la période 1 994-1997. L'aléa moral transitoire est loin d'être négligeable. Son écart-type estimé s'élève à 50 % de la variabilité des coûts due à l'hétérogénéité non observée des hôpitaux. Les simulations montrent que l'on peut attendre des économies budgétaires de 16 % environ de l'application d'une tarification qui prend en compte les hétérogénéités observées entre les hôpitaux et n'élimine que l'aléa moral transitoire.

Suggested Citation

  • Brigitte Dormont & Carine Milcent, 2002. "Quelle régulation pour les hôpitaux publics français ?," Revue Française d'Économie, Programme National Persée, vol. 17(2), pages 117-142.
  • Handle: RePEc:prs:rfreco:rfeco_0769-0479_2002_num_17_2_1463
    Note: DOI:10.3406/rfeco.2002.1463
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    References listed on IDEAS

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    1. Ma, Ching-to Albert, 1994. "Health Care Payment Systems: Cost and Quality Incentives," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 3(1), pages 93-112, Spring.
    2. Ching-to Albert Ma, 1998. "Health-Care Payment Systems: Cost and Quality Incentives-Reply," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 7(1), pages 139-142, March.
    3. Mark McClellan, 1997. "Hospital Reimbursement Incentives: An Empirical Analysis," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 6(1), pages 91-128, March.
    4. Ellis, Randall P., 1998. "Creaming, skimping and dumping: provider competition on the intensive and extensive margins1," Journal of Health Economics, Elsevier, vol. 17(5), pages 537-555, October.
    5. Guillem López-Casasnovas & Marc Saez, 1999. "The impact of teaching status on average costs in Spanish hospitals," Health Economics, John Wiley & Sons, Ltd., vol. 8(7), pages 641-651.
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    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. Biorn, Erik & Hagen, Terje P. & Iversen, Tor & Magnussen, Jon, 2006. "Heterogeneity in Hospitals' Responses to a Financial Reform: A Random Coefficient Analysis of The Impact of Activity-Based Financing on Efficiency," MPRA Paper 8169, University Library of Munich, Germany.
    3. Laurent Gobillon & Carine Milcent, 2008. "Regional disparities in mortality by heart attack: evidence from France," Working Papers halshs-00586837, HAL.

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