Patrick Lenain

The Changing Health System in France

This paper reviews the performance of French health care system from an economic viewpoint. It also provides some policy recommendations. The health system in France is regarded as delivering high quality services, with freedom of choice and generally no waiting lists for treatments. Access to medical services is equal among the population and, unlike in some other countries, people can get the treatments they need irrespective of their social status or work situation. It is therefore not surprising that the French population is relatively satisfied with the health system. As this paper points out, however, this high quality comes at a price: health expenditure in relation to GDP is among the highest in the OECD and risks increasing further in the future in the absence of adequate measures. Past reform efforts, which have shifted the cost to the patient through higher out-of-pocket payments, have proved ineffective and raised equity questions. A new approach is therefore ... Le present document examine la performance du systeme de sante de la France, d’un point de vue economique. Il propose egalement des recommandations pour les reformes futures. Le systeme de sante francais est considere comme capable de fournir des services medicaux de qualite, avec une liberte de choix pour les patients et, en regle generale, sans liste d’attente pour les traitements. Les soins de sante sont distribues de facon equitable au sein de la population et, contrairement a d’autres pays, les patients peuvent obtenir des traitements medicaux quelque soit leur statut social ou professionnel. Il n’est donc pas surprenant que les francais soient relativement satisfaits de leur systeme de sante. Neanmoins, comme souligne dans le present document, la qualite des services medicaux a un prix : les depenses de sante en relation au PIB sont parmi les plus elevees de l’OCDE et elles risquent de s’accroitre davantage a l’avenir en l’absence de mesures adequates. Dans le passe, les ...

Is the Euro Area Converging or Diverging? Implications for Policy Co-ordination

D ESPITE the dire predictions that twelve independent nations would never be able to manage a single currency, the first three years of the euro area have proved to be relatively successful. The European Central Bank (ECB) has kept the area’s economy away from the two risks of high inflation and stagnation. Although it has not been flawless, the changeover to euro cash has happened without major hurdles. With its common central bank, single currency and its growing interdependence, the euro area has increasingly been seen as a coherent macroeconomic entity of significant importance in the international economy. Indeed, if intra-euro area trade is netted out, imports and exports of goods each account for only 15 per cent of GDP, making it a relatively closed economy. One implication of this economic integration is that the twelve participating countries have increasingly followed synchronised fluctuations. A euro area business cycle, not entirely separate from the world economy, but with its own independent properties, has emerged. This is in sharp contrast with the limited degrees of convergence and harmonisation achieved by other trading blocs such as Mercosur and Nafta. Yet, a closer look at the data shows that the various euro area economies do not follow identical cyclical patterns and that a large variance of performance

Is Europe Reforming? Evidence from Cross-Country Structural Indicators

With the adoption of the Lisbon Agenda in 2000, the European Union established for itself the ambitious goal of becoming the most dynamic and competitive economy in the world by 2010. Despite initial optimism, the first half of the decade has been dispiriting and targets established under the Lisbon strategy will be difficult to achieve. Many observers have concluded that governments have failed to implement the policies required to achieve these targets and that, without radical changes, the strategy will fail to deliver its promises. Without disagreeing with these conclusions, the present paper argues that they portray the situation excessively negatively. Using cross-country structural indicators compiled by the OECD, it shows that changes have occurred during the first half of the Lisbon programme, although not everywhere. The first part of the paper reviews recent developments in indicators of labour market policies and labour market performance. It shows that structural policies have moved in the right direction in several countries, notably tax wedges on labour income for low-wage earners and the implicit tax on continued work. This has been associated with a somewhat better labour market performance, notably higher employment rates. As well, the easing of product market regulation, which is deemed to increase the competitive pressure felt by firms and incite them to invest and innovate, has been associated with faster productivity growth in some countries and some industries. Nevertheless, the heterogeneity of performance across countries suggests that there is still a large room for countries where reforms are less advanced to adopt good practices. In these countries, more comprehensive implementation of labour market and product market reforms is needed to mobilise unused labour resources, put productivity growth on a faster trend and accelerate the growth of GDP per capita. Based on this overview, the paper raises some political economy issues related the method of coordination adopted by the Lisbon agenda.

Financial Inclusion and Women Entrepreneurship

Financial inclusion and women entrepreneurship concern policymakers because of their impact on job creation, economic growth and women empowerment. Women in Mexico do engage in paid work but many of them work in the informal sector because they lack opportunities to work in the formal sector. Moreover, financial exclusion rate in Mexico remains the highest amongst OECD countries, affecting women in particular. This paper uses an individual-based panel dataset over the period 2009-2015 to examine the determinants of women entrepreneurship in Mexico and to determine the relationship between women entrepreneurship and financial inclusion across informal and formal work and across economic sectors. The results suggest that financial inclusion is positively linked with entrepreneurship and it can open up economic opportunities for women entrepreneurs. Various financial access points like banking branches, POS terminals, banking agents, ATMs and microfinance banks can be a gateway to the use of additional financial services which can allow businesses development through access to credit facilities. However, the positive relationship between women entrepreneurship and financial inclusion does not hold for women entrepreneurs working in the informal sector or women working in the commerce sector, highlighting lower entry barriers, including financial, in the informal sector and problems pertaining to financial illiteracy. Results also highlight that the probability of a women being an entrepreneur in the informal sector is higher than in the formal sector. Education, age, income, marital status (married or divorced), and income level at the municipality level are amongst other significant determinants which are positively linked with women entrepreneurship. The results also highlight the existence of gender disparity in the status of entrepreneurship across formal and informal work in Mexico. On average, women are about 56% less likely to be entrepreneurs in the formal sector and 63% more likely to be entrepreneurs in the informal sector, as compared to men, after taking into account other relevant individual and municipality level characteristics that are important in explaining entrepreneurship.

Enhancing the Benefits of Financial Liberalisation in Belgium

The Belgian financial landscape has been transformed over the past two decades and now consists of a relatively large, well-functioning and internationally integrated financial sector contributing directly and indirectly, through its intermediary function, to long-term economic growth. One of the financial system’s key characteristics is the concentration of activity among a small number of financial conglomerates that offer a combination of banking and insurance services. Although this mix of activities may contribute to financial stability, it has led to a widespread commercial practice of crossselling, possibly dampening competitive pressures. Competition may also be hindered by regulatory policies in the markets of mortgage loans and consumer credit; although these policies aim at protecting consumers against the risk of over-indebtedness, they risk having the unintended consequence of increasing entry costs for new providers, thus hindering competition and innovation and hurting consumer interests. Besides regulatory policy, tax policy has also been used to shape the development of the financial system. Tax credits are granted to influence investment and borrowing decisions, notably to stimulate home ownership, encourage saving and stimulate private pension accounts. International experience suggests that such tax expenditures, while influencing the allocation of saving, have no obvious impact on the overall level of saving. However they result in significant tax expenditure and necessitate higher tax rates elsewhere. Reforms recommended in this paper would help to make a well-functioning system perform even better. Renforcer les avantages de la liberalisation financiere en Belgique Le paysage financier belge s’est transforme au cours des deux dernieres decennies et se caracterise aujourd’hui par un secteur financier relativement important, fonctionnant bien et integre au niveau international, qui contribue directement et indirectement, par sa fonction d’intermediation, a la croissance economique a long terme. L’une des principales caracteristiques du systeme financier est la concentration de l’activite au sein d’un petit nombre de conglomerats financiers qui offrent simultanement des services bancaires et des services d’assurance. Bien que cette combinaison d’activites puisse contribuer a la stabilite financiere, elle a conduit a une pratique commerciale tres repandue, la vente croisee, qui peut attenuer les pressions concurrentielles. La concurrence est peut-etre aussi entravee par les dispositions reglementaires concernant les marches du credit hypothecaire et du credit a la consommation ; bien que ces dispositions aient pour objet de proteger les consommateurs contre le risque de surendettement, elles peuvent avoir pour consequence involontaire d’accroitre les couts d’entree pour les nouveaux prestataires, et de limiter ainsi la concurrence et l’innovation tout en portant atteinte aux interets des consommateurs. Outre la politique reglementaire, la politique fiscale a ete utilisee pour faconner le developpement du systeme financier. Des credits d’impot sont accordes pour influencer les decisions d’investissement et d’emprunt, en particulier afin de stimuler l’accession a la propriete du logement, encourager l’epargne et promouvoir la constitution de comptes retraite prives. L’experience d’autres pays donne a penser que ces depenses fiscales, si elles influent sur l’affectation de l’epargne, n’ont pas d’impact manifeste sur son niveau global. Or, elles se traduisent par d’importantes depenses fiscales et obligent a relever les taux d’imposition dans d’autres domaines. Les reformes recommandees dans le present article contribueraient a ameliorer encore le fonctionnement du systeme, qui est deja satisfaisant.

The Lisbon Strategy at Midterm: Expectations and Reality

CASE - Center for Social and Economic Research inspired an extensive discussion on the Lisbon Strategy, its goals and objectives, successes and failures. The fervent debate, which took place in Warsaw at the end of 2004, investigated the future of the Strategy in Europe and Poland. The publication, which we are proud to present, is a result of this discussion. The Polish context for achieving the Lisbon goals was explored at a conference on December 9, 2004 entitled “The Lisbon Strategy in Poland: Directions of Necessary Reforms”. Earlier, however, answering the question whether the Lisbon objectives successfully support competitiveness in Europe was of chief concern to a group of scholars and specialists attending the conference entitled “Lisbon Strategy as an Effective Tool of Increasing Competitiveness in Europe?” (The meeting took place in Warsaw on November 8, 2004). The conference dialogue resulted in systematic and inquisitive debate on the causes of successes and failures of the Lisbon Strategy against the background of the current economy in the united Europe. The perspectives for the future implementation of the Strategy and its desired effects also proved to be of great concern. The arguments presented by the authors of the present publication continue the discussion, which has now been enriched by the contributions by conference participants.