Competition, price and quality of care in EHPAD in France: Micro-econometric analyses.

Summary In France, the prices of EHPADs are high in relation to a quality that seems insufficient. The objective of this thesis is to study whether this dilemma can be solved, by analyzing in particular the role of competition, both real and comparative, that could be introduced in this sector. Using a micro-econometric approach, we organize our analysis around three research questions: (i) what can be expected from the proposed reforms of pricing and the increase in the capacity of institutions? (ii) how could the development of the private for-profit sector allow for a reduction in prices and an improvement in quality? (iii) are there environmental constraints responsible for the low quality of EHPAD? We observe, on the one hand, that the reform projects would make it possible to reduce the inefficiency and therefore possibly the prices of EHPADs, but at the expense of their quality. On the other hand, we note that the growth of for-profit EHPADs is accompanied by an increase in fees and a deterioration in the quality of care, which could be moderated by a more competitive market structure. Finally, the EHPADs are confronted with local difficulties in retaining care staff, which affect their quality and which do not seem to be resolved by adjusting salaries. These results can be used as benchmarks for the implementation of an appropriate public policy.