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Stratégies de localisation des médecins généralistes français : mécanismes économiques ou hédonistes ?

Author

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  • Eric Delattre

    (CREST - Centre de Recherche en Économie et Statistique - ENSAI - Ecole Nationale de la Statistique et de l'Analyse de l'Information [Bruz] - X - École polytechnique - ENSAE Paris - École Nationale de la Statistique et de l'Administration Économique - CNRS - Centre National de la Recherche Scientifique)

  • Anne-Laure Samson

    (LEDa - Laboratoire d'Economie de Dauphine - Université Paris Dauphine-PSL - PSL - Université Paris sciences et lettres)

Abstract

En France, la densité médicale est élevée mais les médecins généralistes sont très inégalement répartis sur le territoire. Parce qu'elle renvoie à des questions d'équité et d'efficacité, cette mauvaise répartition constitue aujourd'hui un enjeu majeur de la régulation de la démographie médicale. Un échantillon exhaustif de 9 000 médecins généralistes ayant débuté leur carrière libérale entre 1997 et 2002 est mobilisé afin d'analyser les déterminants des choix individuels de localisation des médecins généralistes et, ainsi, de rendre compte des outils qui pourraient être utilisés spécifiquement au niveau régional pour modifier leurs comportements de localisation. Nous modélisons deux décisions : le choix du changement de région entre la date de la soutenance de la thèse et l'installation et le choix de la région d'exercice pour les seuls médecins qui quittent la région où ils ont soutenu leur thèse. Au travers de ces choix individuels, nous étudions en particulier l'attractivité monétaire des régions afin de déterminer dans quelle mesure les comportements des médecins pourraient être influencés par l'instauration de primes à l'installation dans les zones sous-dotées en médecins. Nous observons un comportement marqué de sédentarité chez les médecins, qui s'installent en grande majorité dans la région de leur thèse. Les politiques doivent donc être orientées, en priorité, vers les étudiants en médecine. Nous montrons par ailleurs que les politiques d'incitation financière à l'installation dans des zones sous-dotées en médecins seraient susceptibles d'influencer la localisation des médecins, même si la modification de la répartition qui en résulterait serait quantitativement d'une faible ampleur. En effet, les primes devraient être d'un montant très élevé pour compenser la perte de qualité de vie consentie par les médecins. Les mécanismes financiers incitatifs ne peuvent donc pas être les seuls leviers de correction des inégalités de répartition des médecins.

Suggested Citation

  • Eric Delattre & Anne-Laure Samson, 2013. "Stratégies de localisation des médecins généralistes français : mécanismes économiques ou hédonistes ?," Post-Print hal-01685914, HAL.
    • Handle: RePEc:hal:journl:hal-01685914
    Note: View the original document on HAL open archive server: https://hal.science/hal-01685914
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    Cited by:

    1. Matthieu Cassou & Julien Mousquès & Carine Franc, 2020. "General practitioners’ income and activity: the impact of multi-professional group practice in France," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(9), pages 1295-1315, December.
    2. Simon Jean-Baptiste Combes & Alain Paraponaris & Yann Videau, 2019. "French GPs’ Willingness to Delegate Tasks: May Financial Incentives Balance Risk Aversion?," Working Papers halshs-02071522, HAL.
    3. Thomas Barnay & Carine Franc & Florence Jusot, 2015. "Introduction : La santé et les soins : prise en charge, déterminants sociaux, conséquences professionnelles," Économie et Statistique, Programme National Persée, vol. 475(1), pages 17-29.
    4. Thomas Barnay & Carine Franc & Florence Jusot, 2015. "Introduction générale. La santé et les soins : prise en charge, déterminants sociaux, conséquences professionnelles," Post-Print hal-02431053, HAL.
    5. Magali Dumontet & Carine Franc, 2015. "Gender differences in French GPs’ activity: the contribution of quantile regressions," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(4), pages 421-435, May.

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