COUDIN Elise

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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.

This thesis develops a finite sample exact inference system in regression and structural models without imposing any parametric assumption on the error distribution. First, we study the construction of tests and confidence regions in a linear regression on the median. The statistics based on the aligned residual signs have a known and simulatable distribution, which allows us to construct a valid simultaneous inference procedure regardless of the sample size. Next, we associate an estimator and study additional inference tools such as the p-value function that gives a confidence level to each tested parameter value. Finally, we extend the procedure to non-linear structural models, by adapting the sign pivotality to the instrumental model. The resulting exact tests do not depend on the degree of identification and are valid in the presence of weak instruments.