Nicolas Da Silva

Medical Altruism in Mainstream Health Economics: Theoretical and Political Paradoxes

In the field of healthcare, ethical considerations are omnipresent. The problem is that it is not clear how to introduce professional ethics within the frontiers demarcated by economic rationality. In mainstream economics, medical altruism is defined as the inclusion of the patients welfare in the doctors utility function. This definition presents two serious problems that we develop in this paper. The first problem is that mainstream theory does not propose a model of authentic altruism because it reduces otherness to a source of utility like any other. The second problem is that ethical and altruistic (instrumental or otherwise) behaviour should not be conflated. By reducing ethics to altruism, mainstream theory prevents any genuine discussion of medical ethics. Then, the thesis of the paper is that the attempt to introduce altruism into the standard framework creates theoretical paradoxes that create policy dilemmas.

Is physician behavior too serious a business to be left to economics? Reply to medical altruism in mainstream health economics: theoretical and political paradoxes

Abstract This short paper is a Reply to ‘Medical altruism in mainstream health economics: theoretical and political paradoxes. COMMENTS’.

Les liens entre la performance médicale et la composition de la patientèle : Une étude économétrique sur les médecins d’Ile-de-France

La convention medicale de 2011 a systematise l’usage du paiement a la performance a travers la Remuneration sur Objectif de Sante Publique (ROSP). Il s’agit d’inciter financierement le medecin a la fourniture d’une medecine de qualite et econome en s’appuyant sur des indicateurs chiffres de resultats. Cet article propose une evaluation du ROSP a partir d’une analyse empirique pionniere en Ile-de-France. Nous testons particulierement l’hypothese selon laquelle la performance d’un medecin est en partie dependante des caracteristiques de sa patientele – la performance etant alors en partie independante de sa responsabilite. Dans cet esprit, nos resultats montrent que les medecins dont la patientele est plus malade ont davantage de chance d’obtenir de meilleurs resultats. Les medecins avec une patientele plus pauvre ont moins de chance d’obtenir de meilleurs resultats.