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La qualité des soins est-elle soluble dans la quantification ? Une critique du paiement à la performance médicale

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  • Nicolas Da Silva

Abstract

The introduction of pay for performance (P4P) in healthcare raises a problem for economists: is quality of care soluble in quantities? The quantified standards of quality used in P4P programs come from the results of Evidence based medicine (EBM) and from its main method of research: random controlled trials. We develop in this paper two major epistemological criticisms of this use of EBM. On the one hand, the implicit epistemology of statistical objects used by this method is problematic: the disease is close to the behavior of 2 the patient and the methodology used in randomized clinical trials is not neutral. On the other hand, it is also questionable to consider care service as product.

Suggested Citation

  • Nicolas Da Silva, 2014. "La qualité des soins est-elle soluble dans la quantification ? Une critique du paiement à la performance médicale," EconomiX Working Papers 2014-31, University of Paris Nanterre, EconomiX.
    • Handle: RePEc:drm:wpaper:2014-31
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    File URL: http://economix.fr/pdf/dt/2014/WP_EcoX_2014-31.pdf
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    Cited by:

    1. Nicolas da Silva & Maryse Gadreau, 2016. "La médecine de ville en France : la grande transformation ?," Post-Print hal-01480888, HAL.
    2. Nicolas da Silva & Amandine Rauly, 2014. "Le difficile déploiement de la télémédecine : une lecture par l'économie des conventions," Post-Print hal-01480878, HAL.

    More about this item

    Keywords

    pay for performance – random controlled trials – evidence based medicine – economic epistemology.;

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • B41 - Schools of Economic Thought and Methodology - - Economic Methodology - - - Economic Methodology

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