WORKING PAPERS 2013

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Production, Productivity and Care Quality in French Hospitals Before and After the Introduction of Activity Based Payment
Or Z. (Irdes), Bonastre J. (IGR, Institut Gustave Roussy), Journeau F. (IGR, Institut Gustave Roussy), Nestrigue C. (Irdes)
Irdes working paper n° 56. 2013/04

Activity based payment (T2A), introduced in 2004-2005 for funding acute care, with the objective of improving efficiency of public and private hospitals as well of the hospital sector. Yet, monitoring of the impact of T2A on hospital activity and productivity has been partial in France. This study provides new data and analyses fol lowing the evolution of hospital activity, productivity and quality of care over the period 2002-2009. By means of a series of indicators estimated annually, we try to answer the following questions: do we produce more or less for every euro spent for the hospital sector since the introduction of T2A? Was the structure of the production modified? How did the quality of the care evolve?

Our results show that, in public hospitals both the number of cases treated and the case-mix adjusted production has increased significantly between 2004 and 2009 and for all types of activities, with a more striking increase in surgery. In private for profit hospitals, a strong increase of ambulatory procedures and surgery was observed simultaneously with a reduction in full-time hospitalizations in obstetrical and medical cases. Overall, we observe an upward trend in the productivity (relationship between the production and the resources used) of public hospitals since 2004 whereas in the private sector, we note a modification of activity (case-mix) more than a significant increase in production and productivity. Besides, the rates of readmission in 30 days for the main cardiovascular diseases and cancer increased since the introduction of the T2A. With the indicators used, we did not observe a strategy of discrimination of the older and multiple-disease patients by hospitals. But the strong increase in the standardized rates of certain interventions/procedures is suggestive of induced demand that is little justified.

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Wage Discrimination According to Health Status in France
Ben Halima M.A. (Irdes), Rococo E. (Irdes)
Irdes working paper n° 55. 2013/03

Using data from the Health, Healthcare and Insurance survey (ESPS), the aim of this research is to estimate wage discrimination based on health status in France in 2010. To measure wage gap according to individuals' health status, the analysis takes into account the endogenous selection of health status and the impact of working conditions on individuals' wages and health using three health indicators: self-perceived health status, activity limitations and long-term chronic illness (ALD). The estimated wage gap between individuals in good and poor health is then decomposed using the Oaxaca and Neumann (2004) method taking into account the endogeneity of health status. The results show the existence of wage discrimination towards individuals in poor health whatever the health indicator.

The hourly wage rate among individuals with a poor self-assessed health status is on average 13.8% lower than among individuals with a good self-assessed health status. This gap narrows, however, for individuals suffering from long-term chronic illness and activity limitations; 6% and 1.2% respectively. Wage gap decomposition shows that the ‘unexplained factor' that can be attributed to wage discrimination amounts to 65% of the wage gap for poor self-assessed health status against 51% for activity limitations and long-term illness.

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Deductibles and the Demand for Prescription Drugs: Evidence from French Data
Kambia-Chopin B. (Ministère de la Santé et des services sociaux du Québec ; Irdes), Perronnin M. (Irdes ; LEDa-LEGOS, Université Paris I)
Irdes working paper n° 54. 2013/02

On January 1st 2008, a 0.5€ deductible levied on every prescription drug package purchased was introduced in France. This study aims at shedding light on the effect of this policy on prescription drug purchasing behavior among the targeted individuals.

Declared behavior from a cross-sectional study based on participants in the French Health, Health Care and Insurance Survey of 2008. The determinants of having changed one's prescription drugs consumption following the introduction of deductibles were explored based on the socio-behavioral model of Andersen and an economic model of drug demand. The empirical analysis used a logistic regression.

All other factors being equal, individuals' probability of having modified their drug consumption behaviour following the introduction of deductibles decreases with income level and health status (self-assessed health and suffering from a chronic disease).

Deductibles on prescription drugs represent a significant financial burden for low-income individuals and those in poor health, with the potential effect of limiting their access to drugs.