SAMSON Anne Laure

We evaluate the impact of a French vaccination campaign against Hepatitis B (HB) in 1994. Usinga regression discontinuity design, we show that this campaign created an exogenous shock on vaccinationbehavior, increasing the vaccination rate for children aged 11 and above. We also show that this vaccinationscheme led to a decline in the knowledge about HB transmission modes, as well as public confusion aboutthe target population. But our most important result is a drop in measles, mumps, and rubella (MMR)vaccination rate and an increase in the belief that measles is a benign disease. We interpret these results asa salience effect: the focus on HB vaccination may lead to a decrease in the beliefs that other vaccines are asimportant. We find that the decrease in MMR vaccination is mostly due to high-educated parents who aremore likely to substitute MMR with HB for their children, and could have been influenced by their familydoctor. The effect on MMR vaccination was relatively unexpected and may imply a negative externality.Measles is an extremely contagious disease. If the vaccination rate falls, the disease will spread further,raising the question of the net effect of the HB vaccination campaign on the well-being of the population.Overall, it shows the necessity - but also the difficulty- to evaluate the effects of a public policy as a whole,taking into account all potential side effects but also unexpected adverse effects.

This article analyzes the impact of health system regulation on physicians' health care supply behavior and how their work fits into the objectives of the French system. Is it possible to reconcile universal and supportive health insurance with a high degree of freedom for private physicians? Results obtained on French data provide a body of evidence scientifically validated by academic publications. They show the importance of the individual preferences of private practitioners in their volume of care and their location, as well as a marked interaction between volumes of care and prices. They exclude that there may be a problem of attractiveness of the private medical profession for financial reasons. They show that the regulation of supply by the number of students admitted to medical studies has had major consequences on income inequalities between generations of doctors. In the current framework where fee-for-service payment is dominant, the management of supply is a narrow path, or rather a challenge, between the plethora of doctors, which leads to losses of efficiency because of induced demand behaviour, and the shortage, which hinders access to care for citizens.

We use four waves of Demographic and Health Surveys from Zimbabwe to evaluate the effect off mother’s and father’s education on child health outcomes. We identify causal effects using the 1980 education reform. A simultaneous-equation model is estimated to take into account possible selection and endogeneity biases. Our results suggest some specialization within parents, as mothers and fathers do not affect the same health outcomes of their under-5 children. Fathers matter more than mothers, and mother’s education improves health only when she is matched to a low-educated man. There is selection in our sample, as is usual. The inverse Mills ratio capturing the likelihood of living with one’s father or mother significantly affects child health. Last, parental educational sorting is shown to be important, so that estimation that does not take both mother’s and father’s education into account will produce biased results.

No summary available.

This paper studies how inter-municipal cooperation, through the creation of a new jurisdictional tier with transferred competencies and tax powers, affects the four main direct local tax rates (business tax, residence tax, property tax on developed land, property tax on undeveloped land) in France. We use an instrumented difference-in-differences method with an original, exhaustive panel of 36,530 French municipalities over the 1994–2010 period. Our estimation results show that inter-municipal cooperation led to an increase in the four (municipal plus inter-municipal) tax rates, which accounts for 35% of the increase observed by the taxpayer on average. Tax increases are greater for the four tax rates when a tax regime consisting in sharing tax-bases between municipal and inter-municipal governments has been adopted. As for municipal tax rates alone, the smaller the municipality, the sharper their decrease. Finally, the heterogeneity of the youth share of the population between municipalities is a key driver of the extent to which the impact of inter-municipal cooperation differs across municipalities.

We evaluate the introduction of various forms of antihypertensive treatments in France with a distribution-sensitive cost-benefit analysis. Compared to traditional cost-benefit analysis, we implement distributional weighting based on equivalent incomes, a new concept of individual well-being that does respect individual preferences but is not subjectively welfarist. Individual preferences are estimated on the basis of a contingent valuation question, introduced into a representative survey of the French population. Compared to traditional cost-effectiveness analysis in health technology assessment, we show that it is feasible to go beyond a narrow evaluation of health outcomes while still fully exploiting the sophistication of medical information. Sensitivity analysis illustrates the relevancy of this richer welfare framework, the importance of the distinction between an ex ante and an ex post approach, and the need to consider distributional effects in a broader institutional setting.

This paper examines whether general practitionersí(GPsí) earnings are high enough to keep this profession attractive. We set up two samples, with longitudinaldata relative to GPs and executives. Those two professions have similar abilities but GPs have chosen a longer education. To measure if they get returns that compensate for their higher investment, we study their career proÖles and construct a measure of wealth for each individual that takes into account all earnings accumulated from the age of 24 (including zero income years when they start their career after 24). The stochastic dominance analysis shows that wealth distributions do not differ significantly between male GPs and executives but that GP wealth distribution dominates executive wealth distribution at the first order for women.Hence, while there is no monetary advantage or disadvantage to be a GP for men, it is more profitable for women to be a self-employed GP than a salaried executive.

Using an exhaustive database, restricted to general practitioners working in private practice between 2005 and 2011, this article studies the determinants of their choice of location within a region, distinguishing four zones: suburban, central city, isolated city, and rural. While individual variables have relatively little influence on the choice of a zone, the characteristics of the local supply and demand for care, the tax exemptions that may be offered and the facilities available in each zone significantly explain their choice. These results are used to simulate the impact of three measures aimed at increasing the number of GPs setting up in rural areas.

No summary available.

We evaluate the introduction of various forms of antihypertensive treatment in France with a distribution-sensitive cost-benefit analysis. Compared to traditional cost-benefit analysis, we implement distributional weighting based on equivalent incomes, a new concept of individual well-being that does respect individual preferences but is not subjectively welfarist. Individual preferences are estimated on the basis of a contingent valuation question, introduced into a representative survey of the French population. Compared to traditional cost-effectiveness analysis in health technology assessment, we show that it is practically feasible to go beyond a narrow evaluation of health outcomes while still fully exploiting the technical sophistication of medical information. Sensitivity analysis illustrates the relevancy of this richer welfare framework, the importance of the distinction between an ex ante and an ex post-approach, and the need to consider distributional effects in a broader institutional setting.

The aim of this paper is to determine if the profession of GP is financially attractive in France.Using longitudinal data, we created two samples of 1,389 self-employed GPs and 4,825 salariedexecutives observed from 1980 to 2004. These two professions require high qualification levels,but studying to become a GP takes longer. To measure if GPs get returns that compensate fortheir investment in education, we analyze GPs’ and executives’ career profiles and construct ameasure of individual wealth that takes into account all earnings from the age of 24, includingyears with no or low income for GPs before they set up their practice.Econometric analysis shows that after an initial period of patient recruitment, physicians experiencea flatter career profile than executives. We also find that GP incomes for recent cohorts arefavored by the low numerus clausus applied when they were in medical school.Stochastic dominance analysis shows that, for men, wealth distributions do not differ significantlybetween GPs and executives, but, for women, GP wealth distribution dominates executive wealthdistribution at the first order. Hence, the relative return on medical studies is higher for women.While for men there is no monetary advantage or disadvantage in being a GP, for women, it ismore profitable to be a GP than an executive. This can explain the large proportion of femaleGPs and the strong increase in the share of women among medical students.

While the prices charged by sector 1 doctors are fixed and regulated, sector 2 doctors are allowed to charge "tactfully" more for the same procedures. Since December 1, 1989, access to sector 2 has been restricted to former heads of clinics and hospital assistants. The purpose of this restriction on access to sector 2 was to regulate the practice of extra fees. This study uses this reform to evaluate empirically the impact of the contracting sector on the supply of care provided by doctors and its composition, as well as on their fees and income. The analysis focuses only on general practitioners, the main specialty affected by the reform. The results suggest a strong impact of tariff regulation on the supply of care. The significant reduction in the rates charged leads, for sector 1 GPs who would have liked to join sector 2, to a higher level of activity than would have been the case if they had actually been able to join sector 2. Men reacted more strongly than women: the increase in their activity was greater, with a significant increase in their income from practice. Price regulation leads to greater accessibility for the doctors concerned, as they see a greater number of patients. Male doctors also perform more on-call duty than they would have done if they had been contracted in sector 2. When their prices are regulated, doctors are also treating a greater number of patients and receive more lump-sum payments in addition to the fee-for-service payment for their private practice.

Summary. . This paper uses a French reform to evaluate the impacts of overbilling restrictions on general practitioner (GP) care provision, fees and incomes. Since 1990, this reform has introduced conditions self-employed GPs must fulfil to be permitted to bill freely. We exploit 2005 and 2008 public health insurance administrative data on GP activity and fees. We use fuzzy regression discontinuity techniques to estimate local causal impacts for GPs who established practices in 1990 and who were constrained by the new regulation to charge regulated prices (compliers). We find that those GPs practices to income effects. In the regulated fee regime, GPs face prices lower by 42% and provide 50% more care than they would do in the unregulated fee regime. Male care provision increasing reaction is larger than the female one, which results in a higher male labour income in the regulated fee regime than with unregulated fees, whereas it is the opposite for women. With regulated fees, GPs limit side-salaried activities, use more lump-sum payment schemes and occupy more often gatekeeper positions. Copyright © 2015 John Wiley & Sons, Ltd.

Some, such as deputy Hervé Mariton in his report on the evolution of local taxation published in 2005, maintain that "inter-municipal cooperation would be a significant factor in the increase of local tax rates in France". The taxation of the communal block increased by 12.09% over the period 1997-2009. Over the same period, the number of Établissements Publics de Coopération Intercommunale (EPCI) increased from 1,446 to 2,601. Is there indeed a causal link between the creation of EPCIs and the increase in local taxation? If so, how does the size of the communes and the EPCI's tax system modify the impact of intermunicipal cooperation on local taxation? What are the different economic mechanisms at work?

No summary available.

No summary available.

The aim of this paper is to provide an assessment of individual uncertainty regarding length of life. We have collected original data through a survey performed in 2009 on a representative sample of 3,331 French people aged 18 or more. The survey design recorded several survival probabilities per individual, which makes it possible to compute (i) subjective life expectancy, defined as the first moment of the individual’s subjective distribution of personal longevity. (ii) the standard error of this distribution, which provides insight on the individual’s uncertainty regarding his or her own longevity. There is considerable between-individual variability in subjective life expectancies, in (small) part explained by age, illnesses, risky behavior, parents’ death and socioeconomic variables. The second main finding is that individual subjective uncertainty about length of life is quite large, equal on average to more than 10 years for men and women. It is logically decreasing with age, but apart from age, very few variables are correlated with it. These results have important consequences for public health and retirement policy issues.

Health equivalent income concept [.].

No summary available.

Orphan drugs (OD) require considerable expenditures, which causes difficulties in their market access. For several years, the price of these new therapies has often been criticized and considered as too high. However few studies about OD pricing mechanisms are available. The aim of the paper is to highlight the main factors that influence OD pricing in France.

We compare two approaches to measuring inequity in the health distribution. The first is the concentration index. The second is the calculation of the inequality in an overall measure of individual well-being, capturing both the income and health dimensions. We introduce the concept of equivalent income as a measure of well-being that respects preferences with respect to the trade-off between income and health, but is not subjectively welfarist since it does not rely on the direct measurement of happiness. Using data from a representative survey in France, we show that equivalent incomes can be measured using a contingent valuation method. We present counterfactual simulations to illustrate the different perspectives of the approaches with respect to distributive justice.

In France, medical density is high but general practitioners are very unevenly distributed throughout the country. Because it raises questions of equity and efficiency, this uneven distribution is now a major issue in the regulation of medical demography. An exhaustive sample of 9,000 general practitioners who began their careers in private practice between 1997 and 2002 is mobilized in order to analyze the determinants of individual location choices of general practitioners and, thus, to report on the tools that could be used specifically at the regional level to modify their location behaviors. We model two decisions: the choice to change region between the date of the thesis defense and the installation and the choice of the region of practice for doctors who leave the region where they have defended their thesis. Through these individual choices, we study in particular the monetary attractiveness of the regions in order to determine to what extent the behaviour of doctors could be influenced by the introduction of installation bonuses in areas with a low number of doctors. We observe a marked sedentary behaviour among physicians, the vast majority of whom settle in the region of their thesis. Policies must therefore be directed, as a priority, towards medical students. We also show that financial incentives to settle in areas with a low supply of doctors could influence the location of doctors, even if the resulting change in distribution would be quantitatively small. Indeed, the premiums would have to be very high to compensate for the loss of quality of life agreed to by the doctors. Financial incentives cannot therefore be the only means of correcting inequalities in the distribution of physicians.

The purpose of this paper is to compare different forms of inter-municipal tax cooperation. We use a tax competition model in a two-tier framework, where the two tax bases are interdependently mobile. We consider three different tax regimes: tax-base sharing for the two tax bases, tax harmonization of one tax rate, and a mixed form of the preceding two regimes. In this framework, both horizontal externalities (at the municipal and inter-municipal level) and vertical tax externalities (bottom-up and top-down) occur. We show that cooperation generates an increase of tax burden, whatever the form of tax cooperation, and we provide a comparison of the different tax regimes.

The first chapter studies the impact of the regulation of medical demography on the careers of general practitioners. We show that the conditions of installation of doctors, which are linked to the numerus clausus, affect their fees in a substantial and lasting way. The analysis in terms of stochastic dominance also shows that the differences linked to individual heterogeneities do not compensate for the considerable differences identified on average for the cohorts. A second chapter focuses on a remarkable phenomenon in the population of general practitioners : the existence of a large minority of doctors with very low incomes. We show that these low incomes result from the greater preference of these physicians for leisure. This very low activity is not a sign of a deterioration in the status of the doctor. It reflects an advantage of the liberal medical profession - doctors can choose to work little. A third chapter evaluates the positioning of general practitioners by comparing their income with that of senior executives. Comparing the career value of physicians and executives provides a measure of the relative advantage of being a physician. The analysis shows that there is a very clear financial advantage to being a general practitioner and that this advantage has increased over time. The existence of an annuity for doctors is the result of the competitive examination for admission to medical school. This rent has evolved positively with the restrictions on the numerus clausus.

The purpose of this thesis is to analyze the remuneration of French general practitioners. Three microeconometric studies are conducted using longitudinal data. The first chapter studies the impact of the regulation of medical demography on the careers of general practitioners. We show that intergenerational inequalities are considerable and that demographic regulation has a strong influence on doctors' fees. Doctors who were installed in the 1980s suffer from the combined impact of the baby boom and a high numerus clausus: they receive the lowest fees. On the other hand, the gradual reduction of the numerus clausus has improved the financial situation of the cohorts installed from the mid-1990s onwards. A second chapter focuses on a remarkable phenomenon in the GP population: the existence of a large minority of low-income doctors. We observe that 5 to 7% of GPs have a monthly income of less than 1.5 SMIC net. We show that these low incomes result from the greater preference of these doctors for leisure activities. This very low activity is not a sign of a deterioration in the status of the doctor. Rather, it reflects an advantage of being a private doctor: doctors can choose to work little A third chapter evaluates the position of general practitioners by comparing their income with that of employees at the top of the salary hierarchy: senior executives. The comparison of the value of the careers of doctors and executives makes it possible to measure the relative advantage of being a doctor. The analysis shows that there is a clear financial advantage to being a general practitioner and that this advantage has increased over time. The existence of an annuity for doctors is the result of the competitive examination for admission to medical school. This rent has evolved positively with the restrictions on the numerus clausus.