Competition by comparison, applications in health economics.

Summary Comparative competition is a regulatory mechanism that relies on comparing the performance of firms facing positively correlated environments. The low diffusion of this mechanism in the economy contrasts with the theoretical interest it arouses. A wider diffusion of the mechanism requires a reflection on the means to compare the performances of entities evolving in heterogeneous environments. The DEA method is a relevant answer to the problem of comparability between firms. The important potential of the DEA method as a comparison method is illustrated in two original applications focused on the health sector. The first aims at estimating the efficiency of hospital facilities in order to assign to each facility a normative ISA point value. The second original application aims at estimating the efficiency of health expenditures at the departmental level using the DEA method.