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Concurrence, prix et qualité de la prise en charge en EHPAD en France : Analyses micro-économétriques

Listed editor(s):
  • Dormont, Brigitte
Registered editor(s):
Listed author(s):
  • Martin, Cécile

High prices and insufficient quality of care are observed in nursing homes in France. Reforms are currently under discussion, but governments are facing a dilemma : any measure of price cut is likely to affect quality and any improvement in quality would probably be inflationary. This work analyzes if this dilemma can be solved by focusing more particularly on the potential effect of real and yardstick competition that could be introduced in this long term care sector. Using a micro-econometric framework, we organize this analysis into three research issues : (i) What might be expected from the pricing reform and the increase in the number of beds in nursing homes currently proposed ? (ii) How the development of for-profit nursing homes could reduce prices and improve quality ? (iii) Are there local difficulties responsible for the poor quality of nursing homes ? Several implications for public policy may be involved. Using cost frontier estimates, we demonstrate that the reform plans would reduce inefficiency and nursing home prices, but at the expense of their quality. The rise of for-profit nursing homes leads to high prices and a deterioration of the quality of care which could be tempered however by a more competitive market structure. Nursing homes face local difficulties in nursing staff retention, affecting their quality and which do not seem to be solved by adjusting wages.

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This book is provided by Paris Dauphine University in its series Economics Thesis from University Paris Dauphine with number 123456789/13712 and published in 2014.
Order: http://basepub.dauphine.fr/xmlui/handle/123456789/13712
Handle: RePEc:dau:thesis:123456789/13712
Note: dissertation
Contact details of provider: Web page: http://www.dauphine.fr/en/welcome.html

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  1. Vitaliano, Donald F. & Toren, Mark, 1994. "Cost and efficiency in nursing homes: a stochastic frontier approach," Journal of Health Economics, Elsevier, vol. 13(3), pages 281-300, October.
  2. Chunping Liu & Audrey Laporte & Brian S. Ferguson, 2008. "The quantile regression approach to efficiency measurement: insights from Monte Carlo simulations," Health Economics, John Wiley & Sons, Ltd., vol. 17(9), pages 1073-1087.
  3. Mehdi Farsi & Massimo Filippini, 2004. "An Empirical Analysis of Cost Efficiency in Non-profit and Public Nursing Homes," Annals of Public and Cooperative Economics, Wiley Blackwell, vol. 75(3), pages 339-365, 09.
  4. Sajal Chattopadhyay & Dennis Heffley, 1994. "Are For-Profit Nursing Homes More Efficient? Data Envelopment Analysis with a Case-Mix Constraint," Eastern Economic Journal, Eastern Economic Association, vol. 20(2), pages 171-186, Spring.
  5. repec:dau:papers:123456789/10722 is not listed on IDEAS
  6. Nyman, John A., 1988. "The marginal cost of nursing home care : New York, 1983," Journal of Health Economics, Elsevier, vol. 7(4), pages 393-412, December.
  7. Roméo Fontaine & Agnès Gramain & Jérôme Wittwer, 2009. "Providing care for an elderly parent: interactions among siblings?," Health Economics, John Wiley & Sons, Ltd., vol. 18(9), pages 1011-1029.
  8. Jean-Baptiste Combes & Eric Delattre & Bob Elliott & Diane Skåtun, 2015. "Hospital staffing and local pay: an investigation into the impact of local variations in the competitiveness of nurses’ pay on the staffing of hospitals in France," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(7), pages 763-780, September.
  9. Pitt, Mark M. & Lee, Lung-Fei, 1981. "The measurement and sources of technical inefficiency in the Indonesian weaving industry," Journal of Development Economics, Elsevier, vol. 9(1), pages 43-64, August.
  10. Mehdi Farsi & Massimo Filippini & Michael Kuenzle, 2005. "Unobserved heterogeneity in stochastic cost frontier models: an application to Swiss nursing homes," Applied Economics, Taylor & Francis Journals, vol. 37(18), pages 2127-2141.
  11. Gaynor, Martin, 2007. "Competition and Quality in Health Care Markets," Foundations and Trends(R) in Microeconomics, now publishers, vol. 2(6), pages 441-508, February.
  12. Darius Lakdawalla & Tomas Philipson, 1998. "Nonprofit Production and Competition," NBER Working Papers 6377, National Bureau of Economic Research, Inc.
  13. Dranove, David & Satterthwaite, Mark A., 2000. "The industrial organization of health care markets," Handbook of Health Economics,in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 20, pages 1093-1139 Elsevier.
  14. Nyman, John A, 1994. "The Effects of Market Concentration and Excess Demand on the Price of Nursing Home Care," Journal of Industrial Economics, Wiley Blackwell, vol. 42(2), pages 193-204, June.
  15. Grabowski, David C. & Feng, Zhanlian & Hirth, Richard & Rahman, Momotazur & Mor, Vincent, 2013. "Effect of nursing home ownership on the quality of post-acute care: An instrumental variables approach," Journal of Health Economics, Elsevier, vol. 32(1), pages 12-21.
  16. Dervaux, B. & Leleu, H. & Nogues, H. & Valdmanis, V., 2006. "Assessing French nursing home efficiency: An indirect approach via budget-constrained DEA models," Socio-Economic Planning Sciences, Elsevier, vol. 40(1), pages 70-91, March.
  17. repec:dau:papers:123456789/13781 is not listed on IDEAS
  18. Nyman, John A & Bricker, Dennis L, 1989. "Profit Incentives and Technical Efficiency in the Production of Nursing Home Care," The Review of Economics and Statistics, MIT Press, vol. 71(4), pages 586-594, November.
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