Carine Milcent

PSE Professor

RePEc page
  • Senior Researcher
  • CNRS
Research groups
Research themes
  • Competition Policy
  • Evaluation of public policies in developing countries
  • Health
  • Health Systems
  • Public policy
  • Social protection
Contact

Address :48 Boulevard Jourdan,
75014 Paris, France

Campus: Campus Jourdan
Floor: 3
Office: 59
Declaration of interest
See the declaration of interest

Tabs

Domaine de recherche

  • Evaluation économique des systèmes de santé en France et dans le monde
  • Inégalités et accès aux soins: déterminants socio-économiques et environnementales
  • Régulation et financement des sytèmes de santé

 

  • Economic evaluation of health systems in France and worldwide
  • Inequalities and access to care: socio-economic and environmental determinants
  • Regulation and financing of health care systems

 

Activités et Engagement Social

Directrice de recherche au CNRS, au PSE (Unité mixte de recherches CNRS-EHESS-ENPC-ENS).

Professeur associé à l’école d’économie de Paris (PSE)

Vice-présidente du conseil scientifique de l’ATIH (Agence Technique de l’Information Hospitalière), au titre de « personnalité qualifiée »

Membre nommé du comité du secret INSEE (Institut National de la Statistiques et des Etudes Economiques)

Présidente de l’Institut d’Analyse des Systèmes de Santé (IA2S)

Membre de l’observatoire national de la myopie – Agissons ensemble contre la myopie https://ensemblecontrelamyopie.fr/observatoire/membres/

Trésorière de la fédération ALTER (lien trauma et résilience) wwww.federationalter.org

Membre du comité de sélection du Programme Fulbright (commission Franco-américaine)

 

Research Director at CNRS (French National Centre for Scientific Research)  

Associated professor at Paris School of Economics (PSE)

Vice-President of the scientific council of the Technical Agency for Hospital Information and Reimbursment System (ATIH), nominated as Qualified Members 

Member of administrative database access committee (INSEE) 

President of the Institute for Healthcare System Analysis (IA2S)

Member of the National Myopia Observatory – Let’s act together against myopia https://ensemblecontrelamyopie.fr/observatoire/membres/

Deputy treasurer of ALTER Federation – (Trauma and Resilience) wwww.federationalter.org

Member de scientific committee selection of the Fulbright Scholar Program (Franco-American Commission) 

 

 

  • « Hospital et distance à l’hôpital », Article Finances Hospitalières, No 194. Octobre 2024
  • « Assessment and Analysis of Healthcare Systems », Healthcare, Guest Editor(s): Carine Milcent. Juillet 2024
    https://www.mdpi.com/journal/healthcare/special_issues/M7020ZEP1H
  • « Comment mesurer la production hospitalière pour la comparer entre les établissements ?», Finances Hospitalières, No 190 – Mai 2024
  • « Les Tarifications à L’activité _ T2A », Finances Hospitalières, No 183 – Octobre 2023
  • « Le tarif des complémentaires santé s’envolent pour les séniors », Le Figaro, le 26/09/2023
  • Tribune  Le Monde « En l’absence d’offre minimale de soins, un système hospitalier à deux vitesses va emerger », 21/06/2022 _ Version complète DOI: https://doi.org/10.5281/zenodo.7149497
  • Tribune Liaisons Sociales Magazines « Faut-il avoir peur de la grande sécu », Numéro 220, pages 42 et 43, 04/02/2022 _ Version complète 
  • Article 5 papers… in 5 minutes! PSE « Does the level of health cover influence medical practices?», Janvier 2022 _ Version complète 
  • Tribune Le Monde « Le projet de « grande Sécu » ne doit pas cloisonner les difficultés de notre système de santé », 11/12/2021 _ Version complète DOI: https://doi.org/10.5281/zenodo.7149750
  • Tribune Le Monde « La gestion de l’épidémie n’est pas qu’une affaire de santé publique mais revêt une dimension économique et politique  », 24/09/2021 _ Version complète DOI: https://doi.org/10.5281/zenodo.7149769 
  • Tribune Le Monde « La crise sanitaire nous amène à tenir compte de la relation entre la consommation et la santé », 16/04/2021 _ Version complète DOI: https://doi.org/10.5281/zenodo.7155693
  • Quotidien du médecin « La situation industrielle française ouvre la voie à une reflexion pour le futur », 19/03/2021  _ Version complète
  • Tribune Le Monde « Vaccins anti-Covid-19 : L’échec de la France est lié à la lourdeur et à la rigidité des instances de régulation », 12/02/2021 _ Version complète DOI: https://doi.org/10.5281/zenodo.7155709
  • Le malaise de l’hôpital public: Etat des lieux après la crise sanitaire du Covid-19, L’Elephant, numéro hors série, mi-octobre 2020 _ Version complète
  • Tribune Le Monde « La saturation des hôpitaux a conduit à innover en matière d’articulation entre les fonctions sanitaire et médico-sociale », 17/06/2020 _ Version complète
  • Article Le Monde diplomatique «   Pourquoi il faut se méfier des chiffres chinois sur le coronavirus », Mensuel, Juin 2020_ Version complète
  • Article Observatoire Mondiale de la Santé (IRIS) « La Chine et La crise sanitaire de COVID-19 », Mai 2020 _ Version complète
  • Article 5 papers… in 5 minutes! PSE « Prenatal care and socioeconomic status: effect on cesarean delivery», Janvier 2019 _ Version complète
  • Article 5 papers… in 5 minutes! PSE « Up-coding and heterogeneity in hospitals’ response: A Natural Experiment», Mai 2018 _ Version complète
  • Article 5 papers… in 5 minutes! PSE « How Do You Feel? The Effect of the New Cooperative Medical Scheme in China», Avril 2016 _ Version complète
  • Article 5 papers… in 5 minutes! PSE « Spatial Disparities in Hospital Performance », Novembre 2013 _ Version complète
  • Article Entretien croisé PSE « Hospital care costs: do State, patients and hospitals have opposite interests? », November 2011 _ Version complète

 

Original published articles in chronological order
 

 

Ongoing Research

 

  • “Ownership and Staff in Chinese Hospitals: Contradictory Effect in Wages, J. Feng and C. Milcent, Work in progress
  • “Transformation d’un espace public médical: entre réformes et E-santé”, C. Milcent, working in progress 

 

Report, Book Survey and Editorial

 

  • Le CNRS en Chine “Systèmes de santé chinois : clés de décryptage”, No 27, 2018. 
    www.cnrs.fr/derci/IMG/pdf/cnrs_en_chine27_fr_1.9mo.pdf
  • Book survey: China’s Social Welfare, Joe C. B. Leung et Yuebin Xu, for China Perspective, No 2016/2
  • Editorial “The Health System and Access to Healthcare in China”, China Perspective, 2016/4.
  • IPP Policy Brief n°16, 2016 https://www.ipp.eu/en/publication/n16-an-evaluation-of-a-physical-activity-programme-designed-for-elderly-people/
  • Book survey: China’s Social Welfare, Joe C. B. Leung et Yuebin Xu, for China Perspective, No 2016/2, 2016
  • Report Institut de Politiques Publiques (IPP) “An evaluation of a physical activity programme designed for elderly people”, 2015
  • Editorial “The Health System and Access to Healthcare in China”, China Perspective, 2016/4, 2016
  • Report: “Geographical disparities in hospital care supply”, report for the French ministry of health (2004-2007)
  • Report: “Variability of hospital costs and prospective payment system”, report for the French ministry of health (1998), with B. Dormont.

 

Working Papers 

 

Published Papers

  • 2022 _ “Existe-t-il des arguments médico-économiques pour développer la chirurgie ambulatoire ?”, Réflexions en Gynécologie Obstétrique (Sept. 2022)

  • 2018 _ “Ownership and hospital productivity”, Dormont B. and Milcent C. (2018), in Competition Between Hospitals, Does it Affect the Quality of Care?, Dormont B. and Milcent C. (eds.), Editions Rue d’Ulm, Paris, pp. 63-113

  • 2018 _ “Competition between hospitals: : Does it Affect Quality of Care ?” Edition rue d’Ulm Collection du Cepremap N.49, Co- Editor-in-chief. Avec la participation de : Andrea AUSTIN, Pedro Pita BARROS, Kurt R. BREKKE, Julie BYNUM, Carrie COLLA, Hugh GRAVELLE, Laurent GOBILLON, Jon MAGNUSSEN, Luigi SICILIANI, Jonathan SKINNER, Odd Rune STRAUME, November 2018. http://www.cepremap.fr/publications/competition-between-hospitals/ 

  • 2003 _ “The Relationship Between Health Policies, Medical Technology Trends and Outcomes: A Perspective from the TECH Global Research Network.” Atella, V and the TECH Investigators. In A Disease-based Comparison of Health Systems: What is Best and at What Cost? Organisation for Economic Co-Operation and Development, 2003

  • 2000 _ “Composante résiduelle des coûts hospitaliers et tarification à la pathologie – Le cas de l’infarctus du myocarde aigu””. B. Dormont and C. Milcent. La Revue française des affaires sociales, (1), 2000

 

 

 

 

 

 

  • 2018 _ “Hospital Institutional Context and Funding” in “Healtchare Reform in China: From Violence to Digital Healthcare”, Milcent C. (eds.), Editions Palgrave Macmillan DOI: 10.1007/978-3-319-69736-9_4

 

  • 2018 _ “Medical Staff” in “Healtchare Reform in China: From Violence to Digital Healthcare”, Milcent C. (eds.), Editions Palgrave Macmillan DOI: 10.1007/978-3-319-69736-9_5

 

  • 2018 _ “Insurance in China” in “Healtchare Reform in China: From Violence to Digital Healthcare”, Milcent C. (eds.), Editions Palgrave Macmillan DOI: 10.1007/978-3-319-69736-9_6

 

  • 2018 _ “The medicine drug market and its reforms” in “Healtchare Reform in China: From Violence to Digital Healthcare”, Milcent C. (eds.), Editions Palgrave Macmillan DOI: 10.1007/978-3-319-69736-9_7

 

 

  • 2018 _ “Digital Healthcare” in “Healtchare Reform in China: From Violence to Digital Healthcare”, Milcent C. (eds.), Editions Palgrave Macmillan DOI: 10.1007/978-3-319-69736-9_9

 

  • 2018 _ “Conclusion – Discussion” in “Healtchare Reform in China: From Violence to Digital Healthcare”, Milcent C. (eds.), Editions Palgrave Macmillan DOI: 10.1007/978-3-319-69736-9_10

 

 

 

  • 2023_ “Telepsychology in Europe since COVID-19: How to Foster Social Telepresence?” Haddouk L., Milcent C., Schneider B., Van Daele T.and De WitteN. Journal of Clinical Medicine, 12(6), 2147. DOI: doi.org/10.3390/jcm12062147

 

 

 

 

 

 

 

 

 

  • 2006 _ “The country of diversity: adjusting hospital payments for heterogeneity in Switzerland”, B. Dormont, C. Milcent, B. Desquins and J. Huguenin, Bulletin de la Société d’études Économiques et Sociales, 2006. 64, 31-52.

 

 

 

 

  • EXTERNCRISE: L’effet des mesures politiques prises pour lutter contre la propagation du virus COVID sur le recours aux soins des patients non COVID et le rôle des déterminants socio- économiques.
    • Période: 03/2022-03/2025

 

  • SAFEPAW _ Déterminants sociétaux pour une e-santé à l’appui de parcours de soins du patient: La santé numérique est une opportunité majeure pour optimiser la gestion et les coûts de nos systèmes de soins de santé. Nous proposons une approche pluridisciplinaire et multidimensionnelle pour étudier l’apport de la santé digitale et la manière dont les différents acteurs peuvent s’en saisir. L’objectif principal est d’évaluer l’impact de l’intelligence artificielle et des outils d’aide à la décision dans les parcours des patients en santé.
    • Période: 06/2024-06/2027

 

 

Fundings Research Programs (since 2019)

SAFEPAW, Societal Assets For E-healthcare Patient pAthWays

  • Project manager
  • ANR-22-PESN-0005, Digital Health PEPR (2024-2027)

 

Dépression du post-partum et conditions socio-économiques au Maroc

  • Co-project manager with Prof. S. Zbiri, University Mohammed IV des sciences et de la santé
  • 2024-2026

 

Myopia: Socio-economic aspects matter?

  • Project manager
  • CEPREMAP (2019)

 

Scientific Expertises (since 2019)

Scientific Council of the Technical Agency for Hospital Information and Reimbursment System (ATIH)

  • Vice president
  • 2019- currently

 

National Statistical Access Committee (Comité du secret statistiques)

  • One of the two researcher representatives
  • 2020- currently

 

 

In the media (excerpt) – since 2019

Writting article for large audience

  • Finance Hospitalières
  • Le monde, Le Monde diplomatique, …

 

Interviews

  • Radio: France Inter, France Culture, France musique, …
  • Press: Libération, l’Express, Le Monde, L’Elephant, …

Most of my courses, including cited references, were online, either on my personal web page or on the website for students of their university

 

Project Coordinator :

ENSAE, France (2000-2001 ; 2006-2007 ; 2011-2014; 2020-2021)

PSE, France (2017- )

 

Graduate: Master and Ph.D. Level Courses

 Econometrics /Statistical Methods for Stochastic Models in Finance and Actuarial Science /Research Methodology in Apply Sciences and Big Data analysis

  • City University of Hong-Kong (2015-2017) – in english
  • University of Paris-Dauphine (2010-2014) – in french
  • Polytechnic University, Hong-Kong (2017-2018) – in english

 

Health Economics     

  • University Mohammed IV (2023- ), Maroc – in french
  • University Federal Fluminense (2024), Brazil – in english
  • CNAM (2011 –  ) – in french
  • Paris School of Economics  (2019 -)  – in french
  • Polytechnic University, Hong-Kong (2017-2018) – in english
  • Universityof Paris-Dauphine, France (2012-2014) – in french
  • Paris School of Economics (PSE), France (2011-2013)– in english
  • Chinese Academy of Social Sciences (CASS), Beijing (2009-2010)

 

Micro-economics            

  • University of Paris-Dauphine (2011-2014) – in french
  • University of Paris-X (1998-2007) – in french

 

Health management and Public Health                 

Polytechnic University, Hong-Kong (2017-2018) – in english

 

Undergraduate Level Courses 


Introduction to Economic Analysis / Micro-economics            

  • University of Paris-Descartes (2012-2015) – in french
  • University of Paris-X (1998-2007) – in french
  • University of Paris IV Sorbonne (1998-2007 and 2011-2012) –in french

Introduction to Health Economics

  • School of Medicine – Paris XIII (1998-2007 and 2011-2012) – in french

Introduction to Econometrics / Statistics                      

  • University of Paris X (1998-2001) – in french
  • University of Paris-X (1998-2001) – in french
  • University of Paris-Descartes (2012-2015)
  • University of Paris-X (1998-2007)

Introduction to Economic Analysis 


  • University of Paris IV-Sorbonne (1998-2007 and 2011-2012)

Introduction to Health Economics

  • CNAM (2011-2014)
  • School of Medicine – Paris XIII (1998-2007 and 2011-2012)

Introduction to Econometrics / Statistics

  • University of Paris X (1998-2001)

 

Ph. D. Thesis or Master Thesis

 

Since 2010      Member of Ph.D. thesis committee (Ph.D. and Master)

Since 2006      Master Thesis supervisor or Member of thesis committee 

****

2014-2019        Ph.D. Thesis S. Zbiri co-direction avec P. Rozenberg, RISCQ, UVSQ, Paris.

2014-2017       Comité de suivi de these Yang Huang Ph.D. Candidate, Paris School of Economics ; Consultant, DECHD, the World Bank

2006-2010       Ph.D. Thesis J. Rochut, co-direction avec A. Holly, EHESS et HEC-Lausanne.

 

 

 

 

– Since 2002: Associate Professor at Paris School of Economics (PSE)

– Since 2002: Researcher at CNRS (French National Centre for Scientific Research)

 

– 2024:  Visiting Professor, Fluminense Federal University, Rio de Januero, Brazil _ Grant from Projeto CAPES PRINT UFF, Brazil

– 2014- 2017: Assigned to CEFC  by the CNRS (French scientific research funding agency), Hong Kong (SAR)

– 2011: Visiting Professor, FuDan University, Shanghai, China

– 2007-2010: Visiting Professor, TsingHua University, Beijing, China

– 2007-2009: Fellow researcher at Chinese Academy of social Science (CASS), Beijing, China

– 2005-2007: Fellow researcher at Health Economics and Health Management Institute (IEMS), Lausanne, Switzerland

– 2002-2005: Visiting associate professor at HEC-Lausanne, Switzerland  

– 2002: Fulbright fellowship grant for a position of visiting scholar at Stanford University, USA.

Refereeing for Quarterly Journal of Economics, Journal of Public Economic, Journal of Health Economics, Health economics Health Policy, The European Journal of Health Economics, Annales d’Economie et de Statistiques, Revue d’Economie Politique, Revue d’Economie et Revue Française d’Economie, Geneva Papers, Louvain Economic Review, China Persperctives

  • Member of the editorial board of Revue de Santé Publique (2022 – )
  • Invited editor for Healthcare Journal, Special issue “Assessment and Analysis of Healthcare Systems”, 2024
  • Member of the editorial board of China Perspectives (2014- 2020)

Publications HAL

  • Frailty Indicator over the Adult Life Cycle as a Predictor of Healthcare Expenditure and Mortality in the Short to Midterm Journal article

    Background: Assessing frailty from middle age onward offers valuable insights into predicting healthcare expenditures throughout the life cycle. Objectives: This paper examines the use of physical frailty as an indicator of healthcare demand across all age groups. The originality of this work lies in extending the analysis of frailty indicators beyond the typical focus on individuals under 50 years old to include those in mid-life and older. Methods: For this study, we used a database where frailty was measured in 2012 in a sample of individuals aged 15 to over 90. These individuals were tracked for their healthcare expenditures from 2012 to 2016. Results: Among the sample of 6928 individuals, frailty in 2012 resulted in a statistically significant increase in costs at the 5% level for the population aged 15 to 65. We applied multilevel linear regression models with year fixed effects, controlling for demographic factors, education level, precarity, social dimensions, lifestyle factors (e.g., vegetable consumption), physical activity, emotional well-being, and medical history. A Hausman test was conducted to validate the model choice. For mortality rate analysis, Cox models were used. Conclusions: Our findings demonstrate that physical frailty provides valuable information for understanding its impact on healthcare expenditure. The effect of frailty on mortality is particularly significant for the elderly population. Moreover, frailty is a predictor of healthcare costs not only in older adults but also across the entire life cycle.
    Journal: Healthcare

    Published in

  • The effect of patients’ socioeconomic status in rehabilitation centers on the efficiency and performance Journal article

    BACKGROUND: Patients’ socioeconomic status on hospitals’ efficiency in controlling for clinical component characteristics may have a role that has few been studied in rehabilitation centers. DESIGN: Because of the national health insurance system, rehabilitation centers are free of charge. To answer whether a patient’s socioeconomic status (SES) is associated with efficiency and performance, we use a counterfactual analysis to get the patient’s SES effect “as if” the patient’s case was identical to whatever hospital. We restrained the data to patients from public acute care units where the decision on rehabilitation sector admission is based on availability, limiting bias by confounding factors. Besides, an analysis of six pathologies led to the same results. SETTING: An exhaustive, detailed administrative database on rehabilitation center stays in France. To define the patients’ socioeconomic status, we use two sources of data: the information collected at the time of the patient’s entry into rehabilitation care and the information collected during the patient’s stay in acute care. This double information avoids possible loss of socio-economic details between the two admissions. POPULATION: Patients recruited were exhaustively admitted over the year 2018 for stroke, chronic obstructive pulmonary disease, heart failure, or total hip replacement in France in the acute care unit and then in a rehab center. Mainly the elderly population. Information on patients’ demography, comorbidities, and SES are coded due to the reimbursement system. Different dimensions controlling for factors (hospital ownership, patient clinical characteristics, rehabilitation care specificities, medical staff detailed information, and patients’ socioeconomic status), were progressively added to control for any differences in baseline data between the two groups. METHODS: We assess rehabilitation centers’ efficiency by combining selected outcome quality indicators (Physical score improvement, Cognitive score improvement, Mortality, Return-to-home). The specific Providers’ Activity Index is used to get the performance index. CONCLUSIONS: The performance of healthcare institutions is correlated not only to the case mix of their patients but also to the socioeconomic status of the patients admitted. The performance needs to be seen in light of patients’ socioeconomic status.
    Journal: European Journal of Physical and Rehabilitation Medicine

    Published in

  • Competition in French hospital: Does it impact the patient management in healthcare? Pre-print, Working paper

    We explore the competition impact on patient management in healthcare (length of stay and technical procedure’s probability to be performed) by difference-indifference , exploiting time variations in the intensity of local competition caused by the French pro-competition reform (2004-2008). Models are estimated with hospital fixed effects to take into account hospital unobserved heterogeneity. We use an exhaustive dataset of in-hospital patients over 35 admitted for a heart attack. We consider the period before the reform from 2001 to 2003 and a period after the reform from 2009 to 2011. Before the reform, there were two types of reimbursement systems. Hospitals from private sector, were paid by fee-for-service. Hospitals from public sector were paid by global budget. They had no current activity’s link, and a weak competition incentive. After the DRG-based payment reform, all hospitals compete with each other to attract patients. We find the reform a sizeable positive competition effect on high-technical procedure for the private sector as well as a negative competition effect on the length of stay for public hospitals. However, the overall local competition effect of the reform explained a very marginal part of the explanatory power of the model. Actually, this period is characterised by two contradictory components: a competition effect of the reform and in-patients who are more concentrated. Results suggest that if competition impacted management patient’s change, it is through a global competition included in a global trend much more than a local competitive aspect of the reform.

    Published in

  • Économie de la santé et des systèmes de santé Books

    Cet ouvrage relatif à l’économie de la santé et des systèmes de santé aborde les concepts clé de l’économie et leur application au champ de l’économie de la santé. Les concepts économiques sont expliqués et documentésà l’aide de nombreux exemples et exercices corrigés en économie de la santé. L’objectif est de comprendre les politiques publiques en santé. Ce manuel étudie ainsi : les principes de l’intervention de l’État (la demande et les besoins de santé…) ;la notion de bien et son caractère public et privé (spécificités des biens en économie, notion de bien privé et bien public…) ;la construction du système de santé, ses objectifs, son évolution future au regard des nouvelles technologies (comprendre les contraintes de l’offre, les tensions, l’offre de bien sur le marché, les choix de production des produits de santé, le traitement des données, etc.) ;les différents modes de tarification et la place de la concurrence ;la notion de qualité (qualité en soins, etc.) ;une analyse d’autres système de santé (Chine, Etats-Unis…).
    Editor: Ellipses

    Published in

  • Competition in French hospital: Does it impact the patient management in healthcare? Journal article

    This research paper examines changes in patient care management in acute care hospitals between 2001 and 2011. During this time, there were two opposing factors at play: the competition effect of the reform and the policymaker’s decision to reduce public hospitals across France. By studying the trends, it is evident that there has been a significant overall shift in patient care management during this period. This change could be attributed to the global competition effect and the concentration of in-patients in specific public facilities. Through the difference-in-difference method, the study analyzed time variations in the intensity of local competition. It was found that local competition had a negligible impact on patient care management. Additionally, the study revealed that there was a significant positive competition effect on high-technical procedures for the private sector, which is in line with the market segment where private sector hospitals have a leadership position and the pro-competitive reform intensified this position. The study also uncovered a negative competition effect on the length of stay for public hospitals. Prior to the implementation of the DRG-based payment reform, public sector hospitals were paid a global budget. However, after the reform was implemented, they had to shorten the length of stay to increase the number of stays. For-profit hospitals have always been paid based on the number of stays. The results are robust and consistent when alternative measures of local competition are used.
    Journal: The B.E. journal of economic analysis & policy

    Published in

  • Bias due to re-used databases: Coding in hospital for extremely vulnerable patients Journal article

    Electronic health records (EHRs) are intended to reduce healthcare costs and improve the quality of care. Nevertheless, usability issues common to EHRs have been identified. In this paper, we investigate these usability issues for social vulnerability codes. Using the acute care EHR and the rehabilitation care EHR databases, hospital stays of 800’000 patients are studied. This article highlights the differences in coding processes between public and private institutions observed when there are different incentives to code. Furthermore, it shows that the differences in coding are not random but depend on the coding strategy. This article emphasises that the reuse of data leads to biases in interpretation. Using the example of social vulnerability alerts policymakers to the need to consider these differences in coding processes when decisions are based on EHR information. Otherwise, this process of coding differences in social vulnerability may exacerbate social inequalities rather than reduce them.
    Journal: Health Policy and Technology

    Published in

  • Staff Resources in Public and Private Hospitals and Their Implication for Medical Practice: A French Study of Caesareans Journal article

    This study aimed to investigate the effect of hospital staffing resources on medical practice in public versus private hospitals. We used exhaustive delivery data from a French district of 11 hospitals over an 11-year period, from 2008 to 2018, including 168,120 observations. We performed multilevel logistic regression models with hospital fixed or random effects, while controlling for factors known to influence obstetric practice. We found that hospital staff ratios of obstetricians and that of midwives affected caesarean rates, but with different effects depending on the hospital sector. In public hospitals, the higher the ratio of obstetricians and that of midwives, the lower the probability of planned caesareans. In private hospitals, the higher the ratio of obstetricians, the greater the probability of planned caesareans. Indeed, in public hospitals, obstetricians and midwives, both salaried employees, do not have financial or organizational incentives to perform more caesareans. In private hospitals, obstetricians, who are independent doctors, may have such incentives. Our results underline the importance of having an adequate supply of health professionals in healthcare facilities to ensure appropriate care, with specific regard to the different characteristics of the public and private sectors.
    Journal: Healthcare

    Published in

  • Stroke but no hospital admission: Lost opportunity for whom? Journal article

    To counter the spread of COVID-19, the French government imposed several stringent social and political measures across its entire population. We hereto assess the impact of these political decisions on healthcare access in 2020, focusing on patients who suffered from an ischemic stroke. We divide our analysis into four distinct periods: the pre-COVID-19 pandemic period, the lockdown period, the “in-between” or transitional period, and the shutdown period. Our methodology involves utilizing a retrospective dataset spanning 2019–2020, an exhaustive French national hospital discharge diagnosis database for stroke inpatients, integrated with income information from the reference year of 2019. The results reveal that the most affluent were more likely to forgo medical care, particularly in heavily affected areas. Moreover, the most disadvantaged exhibited even greater reluctance to seek care, especially in the most severely impacted regions. The data suggest a loss of opportunity for less severely affected patients to benefit from healthcares during this lockdown period, regardless of demographic, location, and socioeconomic determinants. Furthermore, our analysis reveals a notable discrepancy in healthcare-seeking behavior, with less affluent patients and seniors (over 75 years old) experiencing slower rates of return to healthcare access compared to pre-pandemic levels. This highlights a persistent gap in healthcare accessibility, particularly among socioeconomically disadvantaged groups, despite the easing of COVID-19 restrictions.
    Journal: PLoS ONE

    Published in

  • The sorting effect in healthcare access: Those left behind Journal article

    Many governments have sought to enhance patient choice in hospital by intensifying competitive pressure on hospital administrations that is expected to improve efficiency, quality, and innovation. However, there is mixed evidence on whether patients travel past their local hospitals to seek better quality care and whether higher-income patients are those most sensitive to respond to competitive pressures. Using detailed data from 17 million inpatient stays admitted in France during 2019, this paper explores patients’ choice of provider where forprofit, non-profit, research hospital and local hospitals are allowed to compete with each other. We estimate the extent to which deprivation gradient plays on patient’s choice of provider. We found that, in general, patients travel for their care, with just one-quarter of them going to the nearest hospital. In fact, the most vulnerable patients (i.e., those socioeconomically deprived, and very aged) are mostly treated in local public hospitals with the lowest quality service level, and with large variability in quality as well, while those with less socioeconomic deprivation seek care at higher-quality for-profit hospitals. Our counterfactual simulations show that admission to university hospitals attenuates existing inequalities. However, whether it delays the healthcare access sought by this population remains an open question.
    Journal: Economics and Human Biology

    Published in

  • Multiple Prospective Payment System Journal article

    La tarification à l’activité – T2A – est un nom générique qui couvre une multitude de paiements. Par ailleurs, la T2A s’est transformée d’un instrument à un objectif de tarification à trois missions – de tarification, de régulation, et de santé publique –. Il conviendrait plutôt de parler des T2A que de la T2A. De plus, ces différentes missions s’opposent et entraînent des contradictions dans les incitations envoyées par la tutelle aux établissements hospitaliers. Évoquer le retour à un budget global comme solution miracle serait une erreur car cela reviendrait à entériner les effets néfastes des T2A actuelles.
    Journal: Finances hospitalières

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