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- handle: 10670/1.9vys0c
- halshs: halshs-04208620
- doi: 10.1016/j.ehb.2023.101282
- PUBMED: 37531910
- WOS: 001051483900001
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info:eu-repo/semantics/altIdentifier/doi/10.1016/j.ehb.2023.101282
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info:eu-repo/semantics/altIdentifier/pmid/37531910
Mots-clés
Deprivation Ageing Inequality Patient choice Demand for healthcare Rural areas Quality Distance Empirical referral hospital D - Microeconomics/D.D1 - Household Behavior and Family Economics/D.D1.D12 - Consumer Economics: Empirical Analysis I - Health, Education, and Welfare/I.I1 - Health/I.I1.I11 - Analysis of Health Care Markets I - Health, Education, and Welfare/I.I1 - Health/I.I1.I18 - Government Policy • Regulation • Public Health L - Industrial Organization/L.L1 - Market Structure, Firm Strategy, and Market Performance L - Industrial Organization/L.L4 - Antitrust Issues and Policies/L.L4.L44 - Antitrust Policy and Public Enterprises, Nonprofit Institutions, and Professional OrganizationsSujets proches
Health care delivery Health services Personal health services Medical services Medical and health care industry Delivery of medical care Health care Healthcare Delivery of health careCiter ce document
Carine Milcent, « The sorting effect in healthcare access: Those left behind », HAL-SHS : économie et finance, ID : 10.1016/j.ehb.2023.101282
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Résumé
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.