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Essais sur la qualité des soins : approches en économie et en santé publique


  • Dormont, Brigitte


  • Bahrami, Stéphane


This work takes the perspectives of economics and public health to study issues related to the quality of hospital care.The first chapter introduces the concept of quality of care in economics and public health. We show that the two fields use similar definitions of the concept but explore differing and complementary approaches towards its regulation.Fixed price competition between hospitals, as implemented by a prospective payment system, should lead to an improvement of care quality, provided that the demand for care is increasing with quality. The second chapter evaluates the sensitivity to quality of demand for hospital care in France, using ranking lists published by the lay media as a measure of information on quality available to potential patients. We estimate changes in hospital demand caused by ranking lists on a panel of hospitals located in the Paris area, for several pathologies. We find a sizeable and significant demand shift towards hospitals belonging to the top list in the forprofit sector for one pathology. No effect is observed for non-profit hospitals, or for other pathologies in the for profit sector. Competition for quality may thus not be a feasible regulation approach for French public hospitals.The third chapter provides evidence regarding the cost of hospital infection control strategies targeting antimicrobial resistant bacteria. We estimated the burden and costs associated with two types of strategies, relying on targeted screening or on general hygiene promotion strategies, in two multinational controlled clinical trials, in surgical and intensive care units.Our results highlight the variability of costs associated with broad, non-specific hygiene promotion interventions, and, for interventions which were found to be effective by the clinical trials, costs that are consistent with the hypothesis that these interventions are costeffective.

Suggested Citation

  • Bahrami, Stéphane, 2013. "Essais sur la qualité des soins : approches en économie et en santé publique," Economics Thesis from University Paris Dauphine, Paris Dauphine University, number 123456789/14028 edited by Dormont, Brigitte, October.
  • Handle: RePEc:dau:thesis:123456789/14028
    Note: dissertation

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    References listed on IDEAS

    1. Mavrotas, G. & Diakoulaki, D., 1998. "A branch and bound algorithm for mixed zero-one multiple objective linear programming," European Journal of Operational Research, Elsevier, vol. 107(3), pages 530-541, June.
    2. Przybylski, Anthony & Gandibleux, Xavier & Ehrgott, Matthias, 2008. "Two phase algorithms for the bi-objective assignment problem," European Journal of Operational Research, Elsevier, vol. 185(2), pages 509-533, March.
    3. G. L. Nemhauser & Z. Ullmann, 1969. "Discrete Dynamic Programming and Capital Allocation," Management Science, INFORMS, vol. 15(9), pages 494-505, May.
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    More about this item


    Economie de la santé; Qualité des soins; Hôpitaux; Régulation; Évaluation des interventions en santé; Aide à la décision publique; Health economics; Quality of care; Hospitals; Regulation; Health technology assessment; Public decision-making;

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health


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