NAEGELEN Florence

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The purpose of this doctoral thesis is to evaluate the potential effects of increased competition in the health care market. It pays particular attention to the effects of competition on the allocative efficiency of the health care system in terms of health care and health expenditures. Taken together, our results suggest that the canonical effects of competition do not necessarily apply to the health care market, and detail circumstances in which increased competition could harm social welfare. This thesis consists of an introduction and three chapters (academic papers), each focusing on a different aspect of health system efficiency. The first chapter analyzes the impact of competition on hospital care practices and their regulation through prospective pricing. The second chapter details the regulatory issues related to the incomplete nature of patient information when choosing which care procedure to adopt, starting with the decision to implement additional diagnostic tests. The final chapter of this thesis discusses the possible consequences of the asymmetry that may exist between public and private care providers in terms of coverage obligations and can be applied to the market for home care for the elderly.

In France, in 2014, healthcare expenses amounted to 190 billion euros. This amount, which grows year after year, is financed for 76.6% by a social insurance, compulsory and proportional to income, taking care of all residents - the Health Insurance . 13.5% is financed by supplementary insurance and 8.5% directly by households in the form of out-of-pocket expenses. The relationship between public and private insurance is characteristic of mixed systems, in which insurance can complement each other, but can also lead to inefficient interactions. In the first part, we study theoretically a system where public insurance can be complemented by supplementary and/or additional insurance. While there was confusion between these two types of insurance in the literature (Petretto, 1999), we find sometimes opposite effects between complementary and supplementary insurance. Since the marginal utility of the poorest is higher than that of the richest, we find that by simply using the sum of individual utilities as the social welfare utility function, the optimal public insurance rate is positively related to the redistributive character of the insurance.In this first section, we note that the split between what is in the domain of supplementary and supplementary insurance is a function of the definition of the public goods basket. The second chapter studies the optimal composition of this public basket. At the heart of the choice of criteria to be used to select socially reimbursed goods is the possibility of comparing preferences, which has been debated at length in welfare theory and formalized by Arrow's incompatibility theorem. The income-equivalence principle of Fleurbaey et al (2013) proposes to overcome this limitation. This ordinal criterion, defined as income in full health equivalent to income in poor health, allows for interpersonal comparisons. Adapting a theoretical model studying the definition of a social optimal basket (Hoel, 2007) and using the income-equivalent principle, we find that the presence of private insurance changes the ranking of goods that need to be socially covered and reduces the optimal social budget. While the second part of the paper revealed which treatments should not be reimbursed as a priority by the health insurance system in the context of a limited budget, the last chapter studies a market characterized by a very low participation of the social insurance system. The optical market is characterized by information asymmetries and product differentiation. Beyond financing health care expenditures, we wonder whether private insurance is able to reduce these market failures and control health care expenditures. In the context of the literature on managed-care and competition for the right to serve, the last part studies the impact of networks set up by private insurers in the optical market to reduce expenditure. Using a proprietary database assembled by the author on a network of contracted opticians set up by the National Education Mutual Insurance Company (MGEN), the effect of the network on the number of sales and the prices charged is tested empirically. The effect of network and market competition on prices for single vision and bifocal lenses is estimated in 450 groups of French municipalities. Empirically, we find that in-network competition significantly reduces in-network prices, while in-market competition affects out-of-network prices.

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This thesis focuses on the relationship between the EU ETS and energy markets. Particular attention is given to fuel switching, the main means of reducing short-term CO2 emissions in the EU ETS. This consists of substituting gas power plants for coal power plants in off-peak electricity generation. In this way, coal plants operate for shorter periods of time, thereby reducing CO2 emissions. Chapter 1 describes different approaches explaining the relationship between energy and CO2 markets. A literature review is then presented. We give a detailed description of the fuel switching process. In particular, the influence of plant efficiency is analyzed. Chapter 2 provides a theoretical study of the impact of efficiency differences among gas plants for fuel switching. The main result shows that the sensitivity of the CO2 price to the gas price depends on the level of CO2 emissions.Chapter 3 examines the interactions between electricity, coal, gas and CO2 prices in an empirical study. The results show that there is a significant relationship between gas and CO2 in the long-run equilibrium. Chapter 4 investigates the process of discovering the information that influences the price formation of gas and CO2. The strong relationship between gas and CO2 indicates that their prices are affected by the same information. We show in an empirical study that the CO2 market dominates the information discovery process.

The environment is becoming a national and international concern. Indeed, the proposals of the candidates for the French presidency in 2007 have been given environmental ratings. AI Gore and the IPCC received the 2007 Nobel Peace Prize for their research on global warming. The Grenelle de l'environnement is evidence of this new priority given to the environmental issue on political agendas. The climate issue is one of the main scientific concerns after the publication of studies showing an unforeseen acceleration in the amount of carbon in the atmosphere. However, faced with the growing need to intervene to prevent climate risk, governments may be tempted to avoid their environmental obligations by using environmental policy instruments such as taxes or tradable emission permits for commercial purposes. The thesis is therefore structured in two parts. The first part, divided into two chapters, is devoted to an overview of the existing literature on strategic trade policy (Chapter 1), including its environmental dimension (Chapter 2). The second part of the thesis consists of theoretical contributions. We analyze the impact of lobbying by polluting firms on strategic environmental policy in the presence of emission taxes (chapter 3). We present the properties of this same policy with a market of tradable emission permits and the possibility of dominance (or not) of one of the firms on this market (chapter 4).

The objective of this thesis is to introduce a political dimension into the public decision-making process and thus contribute to a new interpretation of public policy-making. The consideration of a political sphere reveals public decision-makers who maximize their own interests rather than promote the general interest. The first part explains the functioning of the political market and the behavior of its actors. The second and third parts consider two specific public policies. First, the regulation of an energy-producing and polluting monopoly is analyzed when the government's welfare objective is influenced by an environmentalist interest group. Second, the definition of a social program with a redistributive purpose is studied, namely the public provision of health care coverage financed by direct taxation, when the government's decision is subject to electoral pressures.

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.

This thesis proposes an economic analysis of several themes that were privileged during the reflection prior to the reform of the public procurement code. It examines the treatment of abnormally low bids, the framework for subcontracting and the choice of a contract. On the basis of a legal and economic analysis, the first chapter shows that an abnormally low bid does not necessarily constitute a predatory price. The second chapter then shows that the negative ex-post profits of certain contract holders are not due to the award of contracts according to the criterion of the lowest bidder, but to a lack of rationality on the part of firms in their apprehension of the uncertain cost of the contract. With regard to the supervision of subcontracting, the aim of the third chapter is to determine whether the public purchaser should impose the announcement of the conditions of subcontracting at the time of the submission of tenders or authorize it after the award of contracts. We determine the conditions for preferring one or the other policy. We also show that the rule that minimizes the expected price is not necessarily the one that leads to the highest probability of obtaining ex-post regret from the contractor. The fourth chapter analyzes the choice of a contract in a context of anti-selection, moral hazard and exogenous uncertainty about the total cost of the contract. A formalization of the procedure with fixed prices renegotiable by riders shows that it remains dominated by a linear incentive contract. We then propose a modification of the payment rule when the firm obtains a rider. We then determine the conditions under which the public purchaser should use either this new contract or a linear incentive contract. Various environments are considered, regarding the public purchaser's objective, the bidders' attitude towards risk, and the audit performance.

Contrary to most theoretical developments, many economic situations involve the simultaneous disposal of several objects of heterogeneous nature. Therefore, when agents can bid on isolated objects and combinations of objects, the auction is said to be complex. The first part of this paper presents a synthesis of the literature generated by the allocation of the American wireless network by the fcc, when thousands of licenses were up for sale. It presents the generalized Vickrey mechanism, the mechanism retained by the fcc and alternative procedures. The second part studies the form of the optimal mechanisms under the assumption of private information of dimension one. We present (chapter 4) the optimal auction for the allocation of two heterogeneous and interdependent objects. Chapter 5 analyzes the awarding procedures of public contracts when SMEs, bidding on specific lots, compete with general contractors, bidding on the whole contract. Rules for the implementation of the optimal procedure are presented and compared with those obtained when smes are allowed to group together in consortia. We extend the analysis by assuming (chapter 6) that firms can reduce their costs by an unobservable effort. We demonstrate the optimality of preference clauses. The last part assumes that agents have multidimensional private information. Chapter 7 presents the form of the two-dimensional optimal auction and demonstrates the necessarily allocatively inefficient nature of the procedure. Chapter 8 analyzes the problem of transferring control rights of a firm when the buyers value both the dividends and the private profits they will be able to obtain from the control activity. We then demonstrate the suboptimality of the classic share structure for the seller.

Most economic work on auction analysis assumes that bidders behave in an uncooperative manner. However, as the facts show, they can coordinate and collude secretly. The purpose of this paper is to study the mechanisms of cartel formation in auctions and tenders and the problem of their prevention and detection. In general, explicit coordination of bidders implies that they exchange private information about the reservation value they assign to an auctioned good or the cost they associate with the realization of a contract awarded by tender, in order to designate among the members of the cartel the one who will be awarded the good or the contract. To the extent that the choice of this agent and the sharing of the cooperative surplus may depend on his announcement, he may have an interest in manipulating the information he reveals. In this context of asymmetric information, the first part of this thesis is devoted to the determination of optimal coordination mechanisms for bidders in the context of given auctions and tenders. The second part of this thesis provides a general reflection on the possibilities of fighting against the formation of cartels, as their presence in an auction or a tender reduces the income of the initiator of the procedure and can have a negative impact on social welfare. The paper analyzes the factors that may favor the formation of cartels, then studies the possibilities of reaction of the initiator of the tender and finally focuses on the influence of the detection risk on the formation of cartels.