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Intégrer les dépenses de santé dans un modèle de microsimulation dynamique : le cas des dépenses de soins de ville

Author

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  • Charlotte Geay
  • Grégoire de Lagasnerie
  • Makram Larguem

Abstract

[fre] Anticiper la croissance à long terme des dépenses de santé constitue un des volets des exercices de surveillance budgétaire qui sont régulièrement menés à différents niveaux, notamment dans le cadre européen. Cette projection peut se faire à l’aide de maquettes macroéconomiques raisonnant à un niveau très agrégé. Mais l’exercice peut aussi se faire par microsimulation, ce qui offre un plus grand potentiel en termes de variantes et de types de résultats. La contrepartie est évidemment une certaine complexité puisqu’il faut modéliser des trajectoires individuelles d’état de santé et la distribution des dépenses associées plutôt que des valeurs moyennes. Cet article présente les premières étapes de la construction d’un modèle de ce type, appliqué aux dépenses de soins de ville. Ce modèle comprend deux modules. Le premier est un module «épidémiologique » qui projette un indicateur dichotomique de bonne / mauvaise santé obtenu en croisant données de santé subjectives et objectives. Cet indicateur est évalué sur le panel de l’enquête santé et protection sociale (ESPS) allant de 2002 à 2008. Ce panel permet d’estimer les probabilités de passage entre bonne et mauvaise santé ainsi que les probabilités de décès différenciées selon l’état de santé. Ce sont ces probabilités qui sont ensuite utilisées pour faire vieillir progressivement l’échantillon de 2008, à l’horizon de 2032. Une fois projetés les états de santé individuels, le second module simule les dépenses qui leur sont associées, à l’aide d’une approche séquentielle simulant d’abord le fait d’avoir une dépense non nulle, puis le niveau de cette dépense si elle est positive. L’articulation de ces deux modules est illustrée par quelques projections exploratoires. Ils ont été conçus pour être applicables à d’autres données de base. Ils pourront aussi être couplés avec des outils de microsimulation appliqués aux autres aspects du vieillissement démographique, principalement les retraites.

Suggested Citation

  • Charlotte Geay & Grégoire de Lagasnerie & Makram Larguem, 2015. "Intégrer les dépenses de santé dans un modèle de microsimulation dynamique : le cas des dépenses de soins de ville," Économie et Statistique, Programme National Persée, vol. 481(1), pages 211-234.
    • Handle: RePEc:prs:ecstat:estat_0336-1454_2015_num_481_1_10636
    DOI: 10.3406/estat.2015.10636
    Note: DOI:10.3406/estat.2015.10636
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