Hélène Huber (EconomiX)

Ageing, health expenditures and inequalities in health care use in France:
a micro-econometric study

Jury :

• Brigitte Dormont, Professeur à l'Université Paris Dauphine, Directeur de thèse
• Pierre-Yves Geoffard, Directeur de Recherche au CNRS
• Alberto Holly, Professeur à l'Université de Lausanne, Rapporteur
• Myriam Khlat, Directrice de Recherche à l'INED, Rapporteur
• Valérie Mignon, Professeur à l'Université Paris X
• Thomas Piketty, Directeur d'Etudes à l'EHESS

Abstract :

This work analyzes health care consumption behaviors. We focus on their impact on the changes in health care expenditures and on health care distribution within the French population. We run analyses on individual data and make use of microsimulations in order to evaluate the effects of the heterogeneity of individual behaviors.

In chapter 1 we outline the econometric methods we use when estimating models of individual health care consumption.

In chapter 2 we describe an original method whose goal is to compare the effects of demographic ageing to other factors driving the growth in health care expenditures that is observed between 1992 and 2000 in France. We show that health expenditures growth is mainly due to changes in behaviors for a given morbidity. These changes are mainly related to technological progress. Ageing plays a minor role in this growth, while health improvements lead to savings.

In chapter 3 we propose an innovative method of the decomposition of health care use inequalities by factors. For a given morbidity, health care consumption is concentrated among the rich ; we show that half of this inequity is due to the heterogeneity of behaviors relative to the rank of individuals in the income distribution. This heterogeneity cannot be identified in the standard decompositions. We propose 3 applications of this method : a decomposition of inequality by factors for France, year 1998, the evaluation of the impact of CMU (universal free care) on the changes in health care use inequalities, and a comparison between the sources of inequality between elderly people (65+) and people aged 15 to 64.

Keywords : Dépense de santé - Econométrie - Micro-simulations - Vieillissement - Inégalités.

JEL codes : C15 - C34 - D63 - I11 - I18 - J11