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Comment évaluer la productivité et l'efficacité des hôpitaux publics et privés ? Les enjeux de la convergence tarifaire

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  • Brigitte Dormont

    (CEPREMAP - Centre pour la recherche économique et ses applications - ECO ENS-PSL - Département d'économie de l'ENS-PSL - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres, LEDa - Laboratoire d'Economie de Dauphine - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres, Legos - Laboratoire d'Economie et de Gestion des Organisations de Santé - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres)

  • Carine Milcent

    (CEPREMAP - Centre pour la recherche économique et ses applications - ECO ENS-PSL - Département d'économie de l'ENS-PSL - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres, PSE - Paris School of Economics - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, PSE - Paris-Jourdan Sciences Economiques - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres - INRA - Institut National de la Recherche Agronomique - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique)

Abstract

Cet article a pour but de comprendre les différences de productivité observées en France entre les hôpitaux publics, les hôpitaux privés à but non lucratif (PSPH) et les cliniques privées. Nous examinons s'il existe une influence de la composition de la patientèle et des séjours sur la productivité des hôpitaux. Si tel est le cas, introduire de la concurrence entre les hôpitaux sur la base de la Tarification à l'Activité ne promeut pas seulement l'efficience, mais crée aussi de fortes pressions au sein des établissements en faveur d'une réorientation de l'offre de soins. La base de données utilisée est un panel d'hôpitaux proche de l'exhaustivité pour les soins aigus : 1 604 hôpitaux sont observés sur la période 1998-2003. L'analyse couvre les six années précédant l'introduction de la T2A en France afin d'observer la situation qui préexistait avant la mise en place de nouvelles incitations. Nous montrons que le diagnostic sur l'efficacité productive des hôpitaux publics dépend de la définition de la frontière de production : avec une fonction classique les scores d'efficacité des hôpitaux publics sont inférieurs à ceux des hôpitaux PSPH, eux-mêmes inférieurs à ceux des cliniques privées. Mais l'ordre des performances relatives s'inverse lorsque l'on tient compte des caractéristiques de la patientèle et la composition des séjours des hôpitaux : à l'exception des petits établissements, les hôpitaux publics et PSPH apparaissent alors plus efficaces que les cliniques privées. Ces résultats doivent être interprétés à la lumière des différences de cahiers des charges encadrant les activités des hôpitaux publics et privés. Une décomposition finale montre que la plus faible productivité des hôpitaux publics s'explique principalement par leur taille, la composition de leur patientèle et celle de leurs séjours, caractérisée par une faible proportion de séjours chirurgicaux. Elle ne s'explique pas par une moindre efficacité des hôpitaux publics.

Suggested Citation

  • Brigitte Dormont & Carine Milcent, 2013. "Comment évaluer la productivité et l'efficacité des hôpitaux publics et privés ? Les enjeux de la convergence tarifaire," PSE-Ecole d'économie de Paris (Postprint) halshs-00833207, HAL.
    • Handle: RePEc:hal:pseptp:halshs-00833207
    Note: View the original document on HAL open archive server: https://shs.hal.science/halshs-00833207
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    References listed on IDEAS

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    1. Jane Despatin & Michel Nakhla & Eric Wable & Yves Auroy, 2015. "Public Performance And Simulation: A Case Study In The French Military Health Service," Post-Print hal-01158733, HAL.

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    More about this item

    Keywords

    Productivité; Efficacité; Hôpital privé; Hôpital public;
    All these keywords.

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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