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Les dépenses de santé des Français : une maladie d'amour?

  • Bruno Ventelou

[fre] Les dépenses de santé des Français croissent plus vite que le PIB, ce qui ne manque pas de poser un problème, manifeste au terme de chaque année budgétaire, à l'équilibre comptable du système de protection sociale. L'analyse microéconomique identifie de multiples raisons à la dérive des dépenses, liées principalement à des lacunes informationnelles entre les acteurs de la relation médicale (le patient, le soignant et l'assureur maladie) : elle plaide pour des réformes structurelles, attentives aux incitations économiques effectivement fournies par le système de santé. L'examen comparé des systèmes de santé étrangers montre que la France ne fait pas exception pour ses difficultés de contrôle de l'évolution de la dépense de santé. Cependant, on peut s'interroger sur la logique des réformes qui ont été appliquées ou qui sont proposée actuellement : elles s'avèrent orientées bien plus vers des mesures de contingentement quantitatif et de contrôle a posteriori que vers la recherche des mutations qualitatives internes au secteur et nécessaires à son bon fonctionnement. [eng] Health care expenditures in France : ailments of love ? Bruno Ventelou In France, health care expenditures increase faster than GDP, which is a recurrent dilemma for the public finance balance of the social protection system. Microeconomic analysis identifies several reasons for such an evolution, linked to informational problems (informational asymmetries between the patient, the physician and the insurance). Microeconomic also provides a large array of incentives and mechanism designs in case of informational asymmetries, and then, inclines in favour of « structural reforms » in order to obtain an efficient health system. Comparative study of health care systems abroad shows that France is not isolated with regard to its difficulties in controlling health expenditures. Nevertheless, economists could be surprised by the reforms implemented in France : they tend to be more oriented toward a (short term) quantitative rationing mechanism rather than toward a (long term) qua- litative and structural response to the existing deficiencies of the health care sector. JEL codes : I10, I11, I18

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File URL: http://dx.doi.org/doi:10.3406/ofce.1999.1560
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File URL: http://www.persee.fr/doc/ofce_0751-6614_1999_num_71_1_1560
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Article provided by Programme National Persée in its journal Revue de l'OFCE.

Volume (Year): 71 (1999)
Issue (Month): 1 ()
Pages: 247-280

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Handle: RePEc:prs:rvofce:ofce_0751-6614_1999_num_71_1_1560
Note: DOI:10.3406/ofce.1999.1560
Contact details of provider: Web page: http://www.persee.fr/collection/ofce

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  1. Blomqvist, A.G. & Carter, R.A.L., 1993. "Is Health Care Really a Luxury?," UWO Department of Economics Working Papers 9311, University of Western Ontario, Department of Economics.
  2. 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.
  3. Jacques Chaperon & Lise Rochaix, 1996. "Les réformes du service national de santé britannique : la fin d'un mythe ?," Économie et Statistique, Programme National Persée, vol. 291(1), pages 87-102.
  4. Jean-Jacques Laffont & Jean Tirole, 1993. "A Theory of Incentives in Procurement and Regulation," MIT Press Books, The MIT Press, edition 1, volume 1, number 0262121743, March.
  5. Yannick L'Horty & Alain Quinet & Frédéric Rupprecht, 1997. "Expliquer la croissance des dépenses de santé : le rôle du niveau de vie et du progrès technique," Économie et Prévision, Programme National Persée, vol. 129(3), pages 257-268.
  6. Lise Rochaix & Stéphane Jacobzone, 1997. "L'hypothèse de demande induite : un bilan économique," Économie et Prévision, Programme National Persée, vol. 129(3), pages 25-36.
  7. Mark V. Pauly, 1974. "Overinsurance and Public Provision of Insurance: The Roles of Moral Hazard and Adverse Selection," The Quarterly Journal of Economics, Oxford University Press, vol. 88(1), pages 44-62.
  8. Gerdtham, Ulf-G. & Sogaard, Jes & Andersson, Fredrik & Jonsson, Bengt, 1992. "An econometric analysis of health care expenditure: A cross-section study of the OECD countries," Journal of Health Economics, Elsevier, vol. 11(1), pages 63-84, May.
  9. Joseph P. Newhouse, 1977. "Medical-Care Expenditure: A Cross-National Survey," Journal of Human Resources, University of Wisconsin Press, vol. 12(1), pages 115-125.
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