Chiara CANTA will defend her HDR (habilitation à diriger des recherches) on « Essays in Health Economics », on December 18th, at 10:30 room MQ 210 (Manufacture des Tabacs).
Supervisor: Helmuth CREMER Professor Toulouse School of Economics and UT Capitole
- Professor Francesca BARIGOZZI, University of Bologna
- Professor Pierre DUBOIS, TSE
- Professor Pierre Pestieau, University of Liège
- Professor Jean-Marie LOZACHMEUR, TSE
- Professor Sato MOTOHIRO, HITOTSUBASHI University
- Professor Helmuth CREMER, TSE
The chapter of “The regulation of health care providers’ when horizontal and vertical differentiation matter” establishes the theoretical model incorporating both quality and location of healthcare providers. The latter can be interpreted as differentiation of their product referred to as “vertical differentiation”. The paper characterizes the optimal reimbursement schemes for providers in this context. The health care providers have incentive to over-differentiate their services to earn rent, which is regarded as market failure. It is then shown that a mixed reimbursement system with a fixed price per treatment and a partial cost sharing can mitigate such market failure offering suboptimal quality.
The paper titled “Public and private hospitals, congestion, and redistribution”, models the hospital market with public and private firms. The patients may choose or be assigned between the two hospitals. The public one is free of charge but there occurs congestion. And patients may have different productivities which are not observable to the government in charge of income redistribution. In this context, the paper establishes that the congestion in the public sector can serve as a screening device mitigating the self-selection/ informational constraint. When the government can assign patients across hospitals, the optimal congestion is higher than in the full information case.“Reference pricing with endogenous generic entry” studies the impact of reference pricing sets caps on the insurance reimbursement of drugs on generic entry, product prices and social welfare in pharmaceutical markets. The theoretical finding is that drug producers are motivated to reduce their prices aggressively, which in turn lowers their profit.Consequently the incentive of generic drug maker to enter the market after patent expiration is undermined. In the long run reference pricing may lead to higher prices despite policy intention of the use of reference pricing. Relatedly, the empirical paper of “Does reference pricing drive out generic competition? Evidence from a policy reform” analyzes the effect of reference pricing on generic entry exploiting data from Norway, to show that reference pricing had a positive impact on generic entry.
The next four papers address optimal financing of long term care. The paper of “Long-term care insurance and family norms” establishes proposes a model of social norm motivated family care which may be transmitted across generations. In the steady state, it is shown that the norm can be weakened by government intervention implying the trade-off between public long-term care insurance and family care. “Long-term care and capital accumulation: the role of the State, the market and the family” considers the overlapping-generations model to see the impact of the public LTC on family care, self-insurance and capital accumulation. It gives the case that Pay you-go public long-term care insurance can serve to enhance private insurance and thus capital accumulation. The intuition is that public LTC can crowd out family care which raises demand for private insurance instead.
In the paper of “Maybe “honor thy father and thy mother” consider the role of public LTC when family care is uncertain. In this context, the (representative) parent is not certain about altruistic preference of own child when he or she becomes dependent. This motivate the parent to save and/or purchase private LTC insurance. The public LTC may take form of either topping up or opting out that affect the intensive margin, i.e., assistance level by the child and the extensive margin, decision of the child of whether or not to assist the parent. It is established that the topping up crowds out both intensive and extensive margins whereas the opting out leads to crowding out only at the extensive margin. Lastly,“Public long-term care insurance with non-linear strategic bequests”, studies the optimal LTC scheme in the case that family care is motivated by strategic bequests. The information on the cost of family care born by the children is private information and the strategic bequest is in place to induce the true revelation of such cost. The government may use a non-uniform policy conditioning public benefit on bequests. It turns out that such policy can provides full insurance.