HEALTH

Scientific project

The ambition of the Health Chair is to help improve the quality of the debate on the issues of efficiency and regulation of the health system. Research is based on themes related to the organization of health insurance systems, regulation of health care provision, health inequalities, criteria for defining reimbursable health outlay and links between health and work. The approach adopted is microeconomic with generally empirical applications.

On health insurance issues, the research focuses on the implications for the design of health insurance of the emergence of genetic tests, which greatly improve the effectiveness of the preventive approach and the introduction, with regard to cure, of precision medicine. There is a need to rethink the regulation of insurance to encourage the use of genetic testing, without individuals suffering adverse consequences in the form of risk selection that would be encouraged by improvement of their observability. Another problem concerns the ethical foundations of a possible definition of sickness insurance premiums according to the age of the individuals: banned at the level of social security financing in France, pricing in accordance with age is nevertheless effective at the level of supplementary insurance, and it has been allowed under the Obama reform in the United States. The question is whether such pricing contravenes or contributes to the principles of solidarity.

On the issues of regulating the supply of care, research focuses on physician location patterns, payment systems and physician incomes. With regard to regulation of hospitals, pricing and incentives to obtain effective quality care are also being examined.

On the issue of health inequality, it is a matter of examining the role of individual responsibility in the differences in health observed between individuals, taking into account the possible correlations between effort and circumstances. The stakes of such studies are assessed in the light of rising concerns around ex ante moral hazard in health insurance (responsibility of individuals for prevention and personal hygiene) and around evaluation of the impact of environmental conditions on health.

A team has been assembled within the Chair on health value Issues, with substantial funding for a contingent assessment survey of 3000 individuals to improve knowledge about French people’s health preferences, their expectations and their trade-off between health and income. The aim is to contribute to the construction of transparent criteria for the definition of reimbursable care outlay, which is ethically more acceptable than the threshold approach applied to Qaly, the method adopted in the United Kingdom, but generalization of which at European level is hampered for various reasons, though partly because of the ethical criticisms levelled at Qalys.

Finally, issues related to the interactions between health and work are addressed in research on the impact of job insecurity on health, and of retirement on physical and mental health.