Health insurance and genetic testing.

Summary This thesis makes three major contributions. The first chapter, an article published in the Revue Française d'Économie n°2/vol XXXIV, proposes a review of the literature on the implications of the regulation of genetic predisposition tests on the health insurance market. We show that current forms of regulation perform a trade-off between maximizing social welfare ex ante and encouraging prevention. This trade-off is conditioned by the way in which the acquisition of information affects agents' prevention and disclosure behaviors, the discrimination of risks by insurers, and the nature of contracts. The second chapter theoretically studies the impact of reclassification on prevention, the decision to test, and social welfare in mandatory disclosure regulation. In particular, we show that as a function of the cost of the prevention effort the individual value of genetic information with reclassification can be higher than without reclassification. In addition, we show how temporal preferences affect the individual value of genetic information. According to our results, social welfare is strictly higher without reclassification than with reclassification. The last chapter studies and characterizes incentive contracts that can be implemented to develop personalized medicine with highly effective treatments, in a context of moral hazard on the firm's effort to improve the effectiveness of the drug. We consider a model in which the health authority has three options. It can apply the same treatment (standard or new treatment) to the whole population or implement personalized medicine, i.e. use genetic information to propose the most appropriate treatment for each patient. We first characterize the drug reimbursement contract of a company producing a new treatment with a companion genetic test when the company can undertake an effort to improve drug quality. Second, we determine the conditions under which personalized medicine should be implemented when this effort is observable and when it is not. Finally, we show how the unobservability of the effort affects the health authority's decision to implement personalized medicine with highly effective treatments.