IDEAS home Printed from https://ideas.repec.org/p/hal/wpaper/hal-04141361.html
   My bibliography  Save this paper

De l’aléa moral du patient aux inégalités d’accès aux soins

Author

Listed:
  • Philippe Batifoulier

    (EconomiX - EconomiX - UPN - Université Paris Nanterre - CNRS - Centre National de la Recherche Scientifique)

Abstract

La théorie de l'aléa moral du patient a justifié l'existence d'un partage des coûts (ticket modérateur, forfait, franchise) de façon à réduire les dépenses sans détériorer l'état de santé. Cette politique a été largement adoptée par les politiques de santé et s'est durcie avec le temps. Cet article montre que le background théorique et empirique de cette conception est largement déficient et conduit à des effets pervers en accroissant les inégalités tout en activant des dépenses nouvelles.

Suggested Citation

  • Philippe Batifoulier, 2014. "De l’aléa moral du patient aux inégalités d’accès aux soins," Working Papers hal-04141361, HAL.
    • Handle: RePEc:hal:wpaper:hal-04141361
    Note: View the original document on HAL open archive server: https://hal.science/hal-04141361
    as

    Download full text from publisher

    File URL: https://hal.science/hal-04141361/document
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. Paul Dourgnon & Florence Jusot & Romain Fantin, 2012. "Payer peut nuire à votre santé : une étude de l’impact du renoncement financier aux soins sur l’état de santé," Working Papers DT47, IRDES institut for research and information in health economics, revised Apr 2012.
    2. repec:adr:anecst:y:2006:i:83-84:p:11 is not listed on IDEAS
    3. Blomqvist, Ake, 2001. "Does the economics of moral hazard need to be revisited? A comment on the paper by John Nyman," Journal of Health Economics, Elsevier, vol. 20(2), pages 283-288, March.
    4. David Bardey & Agnès Couffinhal & Michel Grignon, 2003. "Efficacité et risque moral ex post en assurance maladie," Revue Française d'Économie, Programme National Persée, vol. 18(2), pages 165-197.
    5. Wagstaff, Adam & van Doorslaer, Eddy, 2000. "Chapter 34 Equity in health care finance and delivery," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 34, pages 1803-1862, Elsevier.
    6. repec:dau:papers:123456789/7044 is not listed on IDEAS
    7. Chiappori, Pierre-Andre & Durand, Franck & Geoffard, Pierre-Yves, 1998. "Moral hazard and the demand for physician services: First lessons from a French natural experiment," European Economic Review, Elsevier, vol. 42(3-5), pages 499-511, May.
    8. Philippe Batifoulier & Jean-Paul Domin & Maryse Gadreau, 2011. "Market Empowerment of the Patient: The French Experience," Review of Social Economy, Taylor & Francis Journals, vol. 69(2), pages 143-162.
    9. Office of Health Economics, 2007. "The Economics of Health Care," For School 001490, Office of Health Economics.
    10. Amy Finkelstein & Sarah Taubman & Bill Wright & Mira Bernstein & Jonathan Gruber & Joseph P. Newhouse & Heidi Allen & Katherine Baicker, 2012. "The Oregon Health Insurance Experiment: Evidence from the First Year," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 127(3), pages 1057-1106.
    11. De Jaegher, Kris & Jegers, Marc, 2000. "A model of physician behaviour with demand inducement," Journal of Health Economics, Elsevier, vol. 19(2), pages 231-258, March.
    12. Sandrine Chambaretaud & Laurence Hartmann, 2009. "Participation financière des patients et mécanismes de protection en Europe," Post-Print hal-02109587, HAL.
    13. Philippe Batifoulier & Maryse Gadreau, 2006. "Comportement du médecin et politique économique de santé. Quelle rationalité pour quelle éthique ?," Post-Print halshs-00111914, HAL.
    14. Nyman, John A., 1999. "The value of health insurance: the access motive," Journal of Health Economics, Elsevier, vol. 18(2), pages 141-152, April.
    15. Sandy Tubeuf & Alain Trannoy & Marion Devaux & Florence Jusot, 2008. "La santé des seniors selon leur origine sociale et la longévité de leurs parents," Économie et Statistique, Programme National Persée, vol. 411(1), pages 25-46.
    16. 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.
    17. Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-277, June.
    18. repec:dau:papers:123456789/264 is not listed on IDEAS
    19. Laurent Caussat & Denis Raynaud, 2004. "La régulation de la demande de soins : le rôle de l’assurance maladie dans la formation de la consommation de biens et services de santé," Revue d'Économie Financière, Programme National Persée, vol. 76(3), pages 129-151.
    20. David Rowell & Luke B. Connelly, 2012. "A History of the Term “Moral Hazard”," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 79(4), pages 1051-1075, December.
    21. Amitabh Chandra & Jonathan Gruber & Robin McKnight, 2010. "Patient Cost-Sharing and Hospitalization Offsets in the Elderly," American Economic Review, American Economic Association, vol. 100(1), pages 193-213, March.
    22. Eichner, Matthew J, 1998. "The Demand for Medical Care: What People Pay Does Matter," American Economic Review, American Economic Association, vol. 88(2), pages 117-121, May.
    23. David Bardey & Romain Lesur, 2006. "Optimal regulation of health system with induced demand and 'ex post' moral hazard," Annals of Economics and Statistics, GENES, issue 83-84, pages 279-293.
    24. Gafni, Amiram & Charles, Cathy & Whelan, Tim, 1998. "The physician-patient encounter: The physician as a perfect agent for the patient versus the informed treatment decision-making model," Social Science & Medicine, Elsevier, vol. 47(3), pages 347-354, August.
    25. René C. J. A. van Vliet, 2004. "Deductibles and Health Care Expenditures: Empirical Estimates of Price Sensitivity Based on Administrative Data," International Journal of Health Economics and Management, Springer, vol. 4(4), pages 283-305, December.
    26. Nyman, John A., 1999. "The economics of moral hazard revisited," Journal of Health Economics, Elsevier, vol. 18(6), pages 811-824, December.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Batifoulier, Philippe, 2015. "Aux origines de la privatisation du financement du soin : quand la théorie de l’aléa moral rencontre le capitalisme sanitaire," Revue de la Régulation - Capitalisme, institutions, pouvoirs, Association Recherche et Régulation, vol. 17.
    2. Trottmann, Maria & Zweifel, Peter & Beck, Konstantin, 2012. "Supply-side and demand-side cost sharing in deregulated social health insurance: Which is more effective?," Journal of Health Economics, Elsevier, vol. 31(1), pages 231-242.
    3. Perronnin, Marc, 2013. "Effet de l'assurance complémentaire santé sur les consommations médicales, entre risque moral et amélioration de l'accès aux soins," Economics Thesis from University Paris Dauphine, Paris Dauphine University, number 123456789/13659 edited by Wittwer, Jérôme.
    4. Nyman, John A., 2001. "The income transfer effect, the access value of insurance and the Rand health insurance experiment," Journal of Health Economics, Elsevier, vol. 20(2), pages 295-298, March.
    5. Katherine Baicker & Sendhil Mullainathan & Joshua Schwartzstein, 2015. "Behavioral Hazard in Health Insurance," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 130(4), pages 1623-1667.
    6. Kurt Lavetti & Thomas DeLeire & Nicolas R. Ziebarth, 2023. "How do low‐income enrollees in the Affordable Care Act marketplaces respond to cost‐sharing?," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 90(1), pages 155-183, March.
    7. Matthew Jowett & Anil Deolalikar & Peter Martinsson, 2004. "Health insurance and treatment seeking behaviour: evidence from a low‐income country," Health Economics, John Wiley & Sons, Ltd., vol. 13(9), pages 845-857, September.
    8. Philippe Batifoulier & Nicolas Da Silva, 2014. "The economic behaviour of doctors: medical altruism without an ethic?," EconomiX Working Papers 2014-9, University of Paris Nanterre, EconomiX.
    9. Nicolas Ziebarth, 2014. "Assessing the effectiveness of health care cost containment measures: evidence from the market for rehabilitation care," International Journal of Health Economics and Management, Springer, vol. 14(1), pages 41-67, March.
    10. Tzu-Ting Yang & Hsing-Wen Han & Hsien-Ming Lien, 2014. "Patient Cost-Sharing and Healthcare Utilization in Early Childhood: Evidence from a Regression Discontinuity Design," Working Papers 14C003, Canadian Centre for Health Economics.
    11. Powell, David & Goldman, Dana, 2021. "Disentangling moral hazard and adverse selection in private health insurance," Journal of Econometrics, Elsevier, vol. 222(1), pages 141-160.
    12. Cockx, Bart & Brasseur, Carine, 2003. "The demand for physician services: Evidence from a natural experiment," Journal of Health Economics, Elsevier, vol. 22(6), pages 881-913, November.
    13. Chung Jen Yang & Ying Che Tsai & Joseph J. Tien, 2017. "The Impacts of Persistent Behaviour and Cost-Sharing Policy on Demand for Outpatient Visits by the Elderly: Evidence from Taiwan’s National Health Insurance," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 42(1), pages 31-52, January.
    14. Ponzo, Michela & Scoppa, Vincenzo, 2016. "Cost-Sharing and Use of Health Services in Italy: Evidence from a Fuzzy Regression Discontinuity Design," IZA Discussion Papers 9772, Institute of Labor Economics (IZA).
    15. Ponzo, Michela & Scoppa, Vincenzo, 2021. "Does demand for health services depend on cost-sharing? Evidence from Italy," Economic Modelling, Elsevier, vol. 103(C).
    16. Blomqvist, Ake, 2001. "Does the economics of moral hazard need to be revisited? A comment on the paper by John Nyman," Journal of Health Economics, Elsevier, vol. 20(2), pages 283-288, March.
    17. Toshiaki Iizuka & Hitoshi Shigeoka, 2018. "Free for Children? Patient Cost-sharing and Healthcare Utilization," NBER Working Papers 25306, National Bureau of Economic Research, Inc.
    18. Lucien Gardiol & Pierre-Yves Geoffard & Chantal Grandchamp, 2005. "Separating selection and incentive effects in health insurance," PSE Working Papers halshs-00590713, HAL.
    19. Dunn, Abe, 2016. "Health insurance and the demand for medical care: Instrumental variable estimates using health insurer claims data," Journal of Health Economics, Elsevier, vol. 48(C), pages 74-88.

    More about this item

    Keywords

    Aléa moral du patient; partage des coûts; accès aux soins; inégalités; approche institutionnaliste;
    All these keywords.

    JEL classification:

    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • B52 - Schools of Economic Thought and Methodology - - Current Heterodox Approaches - - - Historical; Institutional; Evolutionary; Modern Monetary Theory;

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:hal:wpaper:hal-04141361. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: CCSD (email available below). General contact details of provider: https://hal.archives-ouvertes.fr/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.