Anne-Laure Samson

Equity in Health And Equivalent Incomes

We compare two approaches to measuring inequity in the health distribution. The first is the concentration index. The second is the calculation of the inequality in an overall measure of individual well-being, capturing both the income and health dimensions. We introduce the concept of equivalent income as a measure of well-being that respects preferences with respect to the trade-off between income and health, but is not subjectively welfarist since it does not rely on the direct measurement of happiness. Using data from a representative survey in France, we show that equivalent incomes can be measured using a contingent valuation method. We present counterfactual simulations to illustrate the different perspectives of the approaches with respect to distributive justice.

GP responses to price regulation: evidence from a French nationwide reform.

This paper uses a French reform to evaluate the impacts of overbilling restrictions on general practitioner (GP) care provision, fees and incomes. Since 1990, this reform has introduced conditions self-employed GPs must fulfil to be permitted to bill freely. We exploit 2005 and 2008 public health insurance administrative data on GP activity and fees. We use fuzzy regression discontinuity techniques to estimate local causal impacts for GPs who established practices in 1990 and who were constrained by the new regulation to charge regulated prices (compliers). We find that those GPs practices to income effects. In the regulated fee regime, GPs face prices lower by 42% and provide 50% more care than they would do in the unregulated fee regime. Male care provision increasing reaction is larger than the female one, which results in a higher male labour income in the regulated fee regime than with unregulated fees, whereas it is the opposite for women. With regulated fees, GPs limit side-salaried activities, use more lump-sum payment schemes and occupy more often gatekeeper positions.

Fairness in cost-benefit analysis: a methodology for health technology assessment

We evaluate the introduction of various forms of antihypertensive treatments in France with a distribution-sensitive cost-benefit analysis. Compared to traditional cost-benefit analysis, we implement distributional weighting based on equivalent incomes, a new concept of individual well-being that does respect individual preferences but is not subjectively welfarist. Individual preferences are estimated on the basis of a contingent valuation question, introduced into a representative survey of the French population. Compared to traditional cost-effectiveness analysis in health technology assessment, we show that it is feasible to go beyond a narrow evaluation of health outcomes while still fully exploiting the sophistication of medical information. Sensitivity analysis illustrates the relevancy of this richer welfare framework, the importance of the distinction between an ex ante and an ex post approach, and the need to consider distributional effects in a broader institutional setting.

Do French low‐income GPs choose to work less?

In France, a significant number of General Practitioners (GPs) earn less than 1.5 times the French minimum salary. Using a representative panel of self-employed GPs over the years 1993-2004, this paper tests whether these low-income GPs choose to work less than all other GPs or whether they are constrained to do so. The test is based on measuring reactions to positive and negative demand shocks. As low-income GPs do not increase activity in response to a positive demand shock but decrease activity in response to a negative demand shock, it appears that their low-income status is attributable to a strong preference for leisure.

Orphan Drug Pricing In France: Influence of Main Factors.

Orphan drugs (OD) require considerable expenditures, which causes difficulties in their market access. For several years, the price of these new therapies has often been criticized and considered as too high. However few studies about OD pricing mechanisms are available. The aim of the paper is to highlight the main factors that influence OD pricing in France.

Individual Uncertainty About Longevity

This article presents an assessment of individual uncertainty about longevity. A survey performed on 3,331 French people enables us to record several survival probabilities per individual. On this basis, we compute subjective life expectancies (SLE) and subjective uncertainty regarding longevity (SUL), the standard deviation of each individual’s subjective distribution of her or his own longevity. It is large and equal to more than 10 years for men and women. Its magnitude is comparable to the variability of longevity observed in life tables for individuals under 60, but it is smaller for those older than 60, which suggests use of private information by older respondents. Our econometric analysis confirms that individuals use private information—mainly their parents’ survival and longevity—to adjust their level of uncertainty. Finally, we find that SUL has a sizable impact, in addition to SLE, on risky behaviors: more uncertainty on longevity significantly decreases the probability of unhealthy lifestyles. Given that individual uncertainty about longevity affects prevention behavior, retirement decisions, and demand for long-term care insurance, these results have important implications for public policy concerning health care and retirement.

Does it pay to be a general practitioner in France

The aim of this paper is to determine if the profession of GP is financially attractive in France. Using longitudinal data, we created two samples of 1,389 self-employed GPs and 4,825 salaried executives observed from 1980 to 2004. These two professions require high qualification levels, but the studies to become a GP are longer. To measure if GPs get returns that compensate for their investment in education, we analyze GPs.and executives.career profiles and construct a measure of individual wealth that takes into account all earnings from the age of 24, including years with no or low income for GPs before they set up their practice. Econometric analysis shows that after an initial period of patient recruitment, physicians experience a fatter career profile than executives. We also find that GP incomes for recent cohorts are favored by the low numerus clausus applied when they were in medical school. Stochastic dominance analysis shows that, for men, wealth distributions do not differ significantly between GPs and executives, but, for women, GP wealth distribution dominates executive wealth distribution at the first order. Hence, the relative return on medical studies is higher for women. While for men there is no monetary advantage or disadvantage in being a GP, for women, it is more profitable to be a GP than an executive. This can explain the large proportion of female GPs and the strong increase in the share of women among medical students.