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Évaluation des politiques de santé : pour une prise en compte équitable des intérêts des populations

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Listed:
  • Marc Fleurbaey
  • Stéphane Luchini
  • Erik Schokkaert
  • Carine Van de Voorde

Abstract

Deux méthodes sont généralement envisagées pour l'évaluation des politiques de santé. L'approche coût-bénéfice s'appuie sur la somme des consentements individuels à payer : elle respecte les préférences individuelles mais elle donne une priorité aux préférences des plus riches car leurs consentements à payer sont en général plus élevés. L'approche coût-efficacité sélectionne les politiques assurant le gain le plus élevé en matière de santé globale, à coût total donné. Elle n'avantage pas les individus à revenu élevé, mais elle peut avoir d'autres effets indésirables : par exemple favoriser le traitement d'une affection bénigne qui profitera au plus grand nombre par rapport à une affection grave touchant peu de personnes. Une variante de l'analyse coût-bénéfice évite ces différents écueils. Elle consiste à pondérer les consentements à payer par des coefficients qui varient en sens inverse d'un indicateur de bien-être individuel combinant revenu et état de santé. L'indicateur choisi est le revenu équivalent santé : il s'agit du revenu effectif de l'individu diminué du montant auquel il serait prêt à renoncer pour être en parfaite santé. À revenu donné, il décroit donc quand la santé se détériore. Contrairement à des indices d'utilité subjective, il a l'avantage de ne s'appuyer que sur les préférences ordinales des individus. Cette approche est mise en œuvre à l'aide d'une enquête conduite sur un échantillon représentatif de la population française. Compte tenu de leurs contraintes financières, les personnes à bas revenu accordent moins d'importance relative à leur état de santé. Mais les coefficients obtenus permettent néanmoins de surpondérer les individus les moins favorisés cumulant faible revenu, mauvaise santé et forte préférence pour l'amélioration de cette santé. Ces coefficients sont ensuite mobilisables pour l'évaluation de toute politique pour laquelle on connaitrait les consentements individuels à payer.
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(This abstract was borrowed from another version of this item.)

Suggested Citation

  • Marc Fleurbaey & Stéphane Luchini & Erik Schokkaert & Carine Van de Voorde, 2012. "Évaluation des politiques de santé : pour une prise en compte équitable des intérêts des populations," Économie et Statistique, Programme National Persée, vol. 455(1), pages 11-36.
  • Handle: RePEc:prs:ecstat:estat_0336-1454_2012_num_455_1_10015
    DOI: 10.3406/estat.2012.10015
    Note: DOI:10.3406/estat.2012.10015
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    1. Anne‐Laure Samson & Erik Schokkaert & Clémence Thébaut & Brigitte Dormont & Marc Fleurbaey & Stéphane Luchini & Carine Van de Voorde, 2018. "Fairness in cost‐benefit analysis: A methodology for health technology assessment," Health Economics, John Wiley & Sons, Ltd., vol. 27(1), pages 102-114, January.
    2. DECANCQ, Koen & FLEURBAEY, Marc & SCHOKKAERT, Erik, 2014. "Inequality, income, and well-being," LIDAM Discussion Papers CORE 2014018, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).

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