Pierre Léger | HEC Montréal (Ecole des Hautes Etudes Commerciales) (original) (raw)
Papers by Pierre Léger
Au Canada et au Québec, l’assurance-maladie publique procure un accès équitable aux soins de sant... more Au Canada et au Québec, l’assurance-maladie publique procure un accès équitable aux soins de santé à tous les individus, indépendamment de leur capacité à payer. Toutefois, cela pourrait se faire au prix d’une surconsommation importante de soins médicaux. En effet, l’apparente gratuité des soins de santé incite les usagers à consommer des services de santé au-delà de ce qui est
A series of shear tests and shake table sliding tests are performed on a 1.5 m high concrete grav... more A series of shear tests and shake table sliding tests are performed on a 1.5 m high concrete gravity dam model with a smooth concrete-concrete frictional interface corresponding to a cold lift joint. The shear tests are performed with the sliding crack (a) in dry, (b) in wet, and (c) in pressurized conditions with peak water uplift pressures, P 0 , equal to 15 kPa, 30 kPa, and 45 kPa. For the pressurized condition, water was fed from a 12.5 mm hole reaching the interface. Monotonic shear tests indicate that the dry dynamic friction coefficient was approximately 15% smaller than the dry static friction coefficient. A reduction of 6 degrees is obtained between the wet and dry friction angles. However, there is a more significant 32% reduction between the wet static friction coefficients versus the wet dynamic friction coefficient.
The journal of mental health policy and economics, 2006
A number of studies have attempted to estimate the aggregate burden of mental illness in particul... more A number of studies have attempted to estimate the aggregate burden of mental illness in particular countries. It has been observed that the economic costs vary by country. This is particularly true for estimates of the cost of schizophrenia, a severe mental illness that can lead to major psychiatric disability. The reasons for this may be due to differences in populations, measurement methods or quality of care. This paper reviews three key studies of the cost of schizophrenia in Canada, the United States and the United Kingdom with an emphasis on a US-Canada comparison. The detailed focus allows for an in-depth study of the factors that lead to different cost estimates. A secondary aim of this paper is to illustrate the importance of direct and indirect costs in the measurement of economic burden. We explore various hypotheses about why three major studies of the economic burden of schizophrenia suggest large differences in the estimated per capita costs when expressed in the same...
SSRN Electronic Journal, 2000
The main question raised in this paper is whether GPs should self select their payment mechanism ... more The main question raised in this paper is whether GPs should self select their payment mechanism or not. To answer it, we model GPs' behavior under the most common payment schemes (capitation and fee-for-service) and when GPs can select one among those. Our analysis considers GPs heterogeneity in terms of both ability and sense of professional duty. We conclude that when savings on specialists costs are the main concern of a regulator, GPs should be paid on a fee-for-service basis. Instead, when failures to identify severe conditions are the main concern, then payment self selection by GPs can be optimal.
The migration of highly-skilled workers is becoming an important fac- tor in the world economy. H... more The migration of highly-skilled workers is becoming an important fac- tor in the world economy. However, there is little consensus as to what constitutes a high-skilled worker. High-skilled workers are often de…ned by their education level and/or their profession and/or their wage, none of which is satisfactory. In this article, we oer a precise de…nition of what is meant by being highly skilled: earning a higher wage than other- wise predicted based on observed human capital. Using a 10-year panel of migration decisions for the whole population of physicians in Canada, we test whether skills are related to mobility by modelling simultaneously their wage determination process and migration decision.
Au Canada et au Québec, l’assurance-maladie publique procure un accès équitable aux soins de sant... more Au Canada et au Québec, l’assurance-maladie publique procure un accès équitable aux soins de santé à tous les individus, indépendamment de leur capacité à payer. Toutefois, cela pourrait se faire au prix d’une surconsommation importante de soins médicaux. En effet, l’apparente gratuité des soins de santé incite les usagers à consommer des services de santé au-delà de ce qui est efficace pour l’ensemble de la société. Il en résulte des coûts importants qui contribuent à augmenter les dépenses gouvernementales en santé. Cela n’est pas sans lien avec la situation actuelle des finances publique du Québec. Cette surconsommation peut cependant être réduite par des mécanismes provenant de la demande (co-paiement, ticket modérateur) ou de l’offre (forme de rémunération des médecins). Le recours à des systèmes de rémunération plus efficaces pour les médecins permettrait de réduire le coût des soins de santé et d’encourager une provision efficace de ceux-ci. Plusieurs mécanismes de paiements ...
In this paper, we examine the effect of increases in health care costs and general inflation on o... more In this paper, we examine the effect of increases in health care costs and general inflation on optimal insurance policies and waste in a model of imperfect information with costly auditing. We show that in such a setting, individuals will buy more than full insurance. Moreover, as the cost of medical increases, consumers (i.e., patients) reduce their probability of filing injustified claims, at the same time as insurance providers audit with lower probability. As a result, waste associated with costly auditing is reduced. We also show that a general increase in the opportunity cost of illness (reflected through lost wages due to illness) also decreases the likelihood of false claims, of auditing and thus of waste, but not as much as health care costs increase. Nous étudions dans ce document de recherche l'impact d'une augmentation des coûts des soins de santé et de l'inflation en général sur le contrat optimal d'assurance médicale et sur le gaspillage dans une écono...
SSRN Electronic Journal, 2000
SSRN Electronic Journal, 2000
SSRN Electronic Journal, 2000
Group-based incentives can reduce a firm’s costs more than individual incentives by providing a r... more Group-based incentives can reduce a firm’s costs more than individual incentives by providing a rationale for standardizing decisions across employees or agents. We theoretically demonstrate and empirically test this in the context of hospital services, where fragmentation between hospitals and physicians has promoted high growth in spending. Specifically, we analyze recent gainsharing programs in cardiology in which hospitals establish group incentives for their nonemployee physicians to control spending on highly-priced drugs and devices. We find that gainsharing lowered hospitals’ spending on devices, and this occurred from both greater negotiating power and standardizing purchasing on lower-priced items. The model describes the conditions under which each of these outcomes is achieved. We also find that the incentives had the greatest effect on groups that were most costly and least standardized prior to gainsharing. However, we do not find evidence of differences by group size,...
Journal of Population Economics, 2009
Several papers have tested the empirical validity of the migration models proposed by and . Howev... more Several papers have tested the empirical validity of the migration models proposed by and . However, to our knowledge, none has been able to disentangle the separate impact of observable and unobservable individual characteristics, and their respective returns across different locations, on an individual's decision to migrate. We build a model in which individuals sort, in part, on potential earningswhere earnings across different locations are a function of both observable and unobservable characteristics. We focus on the inter-provincial migration patterns of Canadian physicians. We choose this particular group for several reasons including the fact that they are paid on a fee-for-service basis. Since wage rates are exogenous, earning differentials are driven by differences in productivity. We then estimate a mixed conditional-logit model to determine the effects of individual and destination-specific characteristics (particularly earnings differentials) on physician location decisions. We find, among other things, that high-productivity physicians (based on unobservables) are more likely to migrate to provinces where the productivity premium is greater, while low-productivity physicians are more likely to migrate to areas where the productivity premium is lower. These results are consistent with a modified Borjas model of self-selection in migration based on both unobservables and observables. JEL Classification: J24, J61, C23, C35
Journal of Health Economics, 2011
In this paper, we propose a theoretical model where health can evolve over time and where GPs di¤... more In this paper, we propose a theoretical model where health can evolve over time and where GPs di¤er in their diagnosis ability and level of altruism. In our model, certain types of illnesses, which may or may not require specialty care, are assumed to be diagnosed with potential error -where the diagnostic precision depends on the GPs diagnostic ability. Finally, we assume that certain types of illnesses may worsen over time if they are not treated with appropriate care. We solve for the GP's treatment and referral decisions which maximize the patient's expected utility (subject to GPs' and Specialists'participation constraints) as a function of the GP's diagnostic ability (what we call the First-Best outcome). We then consider three common types of physician payment mechanisms: fee-for-service, capitation and fundholding. For each, we derive the GPs' utility maximizing treatment and referral decisions as a function of their diagnostic and altruism level. For each payment mechanism we compare the treatment and referral decisions of di¤erent types of physicians to those derived under the First-Best. Finally, we examine GPs'behaviour across di¤erent types of payment mechanisms in order to identify which one yields the best outcomes (in utility terms).
Journal of Economics & Management Strategy, 2009
We examine provider and patient behavior in a dynamic model where effort is noncontractible, comp... more We examine provider and patient behavior in a dynamic model where effort is noncontractible, competition between providers is modeled in an explicit way and where patients' outside options are solved for in equilibrium. Physicians are characterized by an individual-specific ethical constraint which allows for unobserved heterogeneity. This introduces uncertainty in the patient's expected treatment if he were to leave his current physician to seek care elsewhere. We also introduce switching costs and uncertainty in the treatment-outcome relationship. Our model generates equilibria with treatment heterogeneity, unstable physician-patient relationships, and overtreatment (a form of defensive medicine).
Journal of Computing in Civil Engineering, 1991
ABSTRACT Specialized computer‐aided education tools are necessary to provide a transition between... more ABSTRACT Specialized computer‐aided education tools are necessary to provide a transition between theoretical formulations of matrix methods of structural dynamic computations and the fully automated analysis procedures found in general‐purpose analysis packages. This paper presents an interactive computer graphics program, CAL/CGI, that has been developed to represent the relationship between each stage of the formulation, solution, and interpretation of linear static and dynamic structural analysis problems. A modified version of the CAL program, an educational tool for computer‐assisted learning of structural analysis, is used to produce user‐defined matrices that can be visually interpreted by CAL/CGI. A brief overview of CAL and a description of the capabilities of the CAL/CGI module are presented and illustrated using simple examples.
Health Economics, 2005
HEC), Montréal. Tous droits réservés pour tous pays. Toute traduction ou toute reproduction sous ... more HEC), Montréal. Tous droits réservés pour tous pays. Toute traduction ou toute reproduction sous quelque forme que ce soit est interdite. Les textes publiés dans la série des Cahiers de recherche HEC n'engagent que la responsabilité de leurs auteurs. La publication de ce Cahier de recherche a été rendue possible grâce à des subventions d'aide à la publication et à la diffusion de la recherche provenant des fonds de l'École des HEC. Direction de la recherche, École des HEC, 3000, chemin de la Côte-Sainte-Catherine, Montréal (Québec) Canada H3T 2A7.
Engineering Structures, 1994
ABSTRACT
Engineering Structures, 2005
A theoretical model is developed for transient water pressure variations along a tensile seismic ... more A theoretical model is developed for transient water pressure variations along a tensile seismic concrete crack with known crack wall motion history. Experimental tests are performed to validate the proposed model. Experimental and numerical results show that water can penetrate into new seismic cracks making them partially saturated over a length L sat . The magnitude of L sat and the total water uplift force acting on a crack wall are decreased by crack opening and increased by crack closing. The model is then implemented in a nonlinear discrete crack finite element program for seismic analysis of concrete dams. A 90 m high gravity dam subjected to two different ground accelerations is analysed. The magnitude of uplift force in the opening mode of the crack is small such that the downstream sliding safety factor (SSF) during crack opening is similar to the SSF assuming zero uplift force in the crack. Although the transient uplift force during crack closing reduces the upstream SSF, compared to a similar value assuming zero uplift force in the crack, its magnitude still remains larger than the minimum downstream SSF corresponding to the crack opening mode.
Computers & Structures, 1990
There is currently a lack of specialized educational software for the teaching of matrix structur... more There is currently a lack of specialized educational software for the teaching of matrix structural analysis. Presented are the development and application of an interactive computer graphics program, CAL/CGI, to complement an enhanced version of the CAL program which has been used extensively for teaching matrix structura1 analysis. The basic commands of the CALjCGI program are summarized and its application to support the understanding of the theory of the direct stiffness method is illustrated using simple examples
In many health%care systems, individuals are fully insured but often face long waiting times. Alt... more In many health%care systems, individuals are fully insured but often face long waiting times. Although the introduction of a private sector may allow individuals to avoid long waiting times, care can be very ex% pensive. In this paper, we build a model where patients may ...
Au Canada et au Québec, l’assurance-maladie publique procure un accès équitable aux soins de sant... more Au Canada et au Québec, l’assurance-maladie publique procure un accès équitable aux soins de santé à tous les individus, indépendamment de leur capacité à payer. Toutefois, cela pourrait se faire au prix d’une surconsommation importante de soins médicaux. En effet, l’apparente gratuité des soins de santé incite les usagers à consommer des services de santé au-delà de ce qui est
A series of shear tests and shake table sliding tests are performed on a 1.5 m high concrete grav... more A series of shear tests and shake table sliding tests are performed on a 1.5 m high concrete gravity dam model with a smooth concrete-concrete frictional interface corresponding to a cold lift joint. The shear tests are performed with the sliding crack (a) in dry, (b) in wet, and (c) in pressurized conditions with peak water uplift pressures, P 0 , equal to 15 kPa, 30 kPa, and 45 kPa. For the pressurized condition, water was fed from a 12.5 mm hole reaching the interface. Monotonic shear tests indicate that the dry dynamic friction coefficient was approximately 15% smaller than the dry static friction coefficient. A reduction of 6 degrees is obtained between the wet and dry friction angles. However, there is a more significant 32% reduction between the wet static friction coefficients versus the wet dynamic friction coefficient.
The journal of mental health policy and economics, 2006
A number of studies have attempted to estimate the aggregate burden of mental illness in particul... more A number of studies have attempted to estimate the aggregate burden of mental illness in particular countries. It has been observed that the economic costs vary by country. This is particularly true for estimates of the cost of schizophrenia, a severe mental illness that can lead to major psychiatric disability. The reasons for this may be due to differences in populations, measurement methods or quality of care. This paper reviews three key studies of the cost of schizophrenia in Canada, the United States and the United Kingdom with an emphasis on a US-Canada comparison. The detailed focus allows for an in-depth study of the factors that lead to different cost estimates. A secondary aim of this paper is to illustrate the importance of direct and indirect costs in the measurement of economic burden. We explore various hypotheses about why three major studies of the economic burden of schizophrenia suggest large differences in the estimated per capita costs when expressed in the same...
SSRN Electronic Journal, 2000
The main question raised in this paper is whether GPs should self select their payment mechanism ... more The main question raised in this paper is whether GPs should self select their payment mechanism or not. To answer it, we model GPs' behavior under the most common payment schemes (capitation and fee-for-service) and when GPs can select one among those. Our analysis considers GPs heterogeneity in terms of both ability and sense of professional duty. We conclude that when savings on specialists costs are the main concern of a regulator, GPs should be paid on a fee-for-service basis. Instead, when failures to identify severe conditions are the main concern, then payment self selection by GPs can be optimal.
The migration of highly-skilled workers is becoming an important fac- tor in the world economy. H... more The migration of highly-skilled workers is becoming an important fac- tor in the world economy. However, there is little consensus as to what constitutes a high-skilled worker. High-skilled workers are often de…ned by their education level and/or their profession and/or their wage, none of which is satisfactory. In this article, we oer a precise de…nition of what is meant by being highly skilled: earning a higher wage than other- wise predicted based on observed human capital. Using a 10-year panel of migration decisions for the whole population of physicians in Canada, we test whether skills are related to mobility by modelling simultaneously their wage determination process and migration decision.
Au Canada et au Québec, l’assurance-maladie publique procure un accès équitable aux soins de sant... more Au Canada et au Québec, l’assurance-maladie publique procure un accès équitable aux soins de santé à tous les individus, indépendamment de leur capacité à payer. Toutefois, cela pourrait se faire au prix d’une surconsommation importante de soins médicaux. En effet, l’apparente gratuité des soins de santé incite les usagers à consommer des services de santé au-delà de ce qui est efficace pour l’ensemble de la société. Il en résulte des coûts importants qui contribuent à augmenter les dépenses gouvernementales en santé. Cela n’est pas sans lien avec la situation actuelle des finances publique du Québec. Cette surconsommation peut cependant être réduite par des mécanismes provenant de la demande (co-paiement, ticket modérateur) ou de l’offre (forme de rémunération des médecins). Le recours à des systèmes de rémunération plus efficaces pour les médecins permettrait de réduire le coût des soins de santé et d’encourager une provision efficace de ceux-ci. Plusieurs mécanismes de paiements ...
In this paper, we examine the effect of increases in health care costs and general inflation on o... more In this paper, we examine the effect of increases in health care costs and general inflation on optimal insurance policies and waste in a model of imperfect information with costly auditing. We show that in such a setting, individuals will buy more than full insurance. Moreover, as the cost of medical increases, consumers (i.e., patients) reduce their probability of filing injustified claims, at the same time as insurance providers audit with lower probability. As a result, waste associated with costly auditing is reduced. We also show that a general increase in the opportunity cost of illness (reflected through lost wages due to illness) also decreases the likelihood of false claims, of auditing and thus of waste, but not as much as health care costs increase. Nous étudions dans ce document de recherche l'impact d'une augmentation des coûts des soins de santé et de l'inflation en général sur le contrat optimal d'assurance médicale et sur le gaspillage dans une écono...
SSRN Electronic Journal, 2000
SSRN Electronic Journal, 2000
SSRN Electronic Journal, 2000
Group-based incentives can reduce a firm’s costs more than individual incentives by providing a r... more Group-based incentives can reduce a firm’s costs more than individual incentives by providing a rationale for standardizing decisions across employees or agents. We theoretically demonstrate and empirically test this in the context of hospital services, where fragmentation between hospitals and physicians has promoted high growth in spending. Specifically, we analyze recent gainsharing programs in cardiology in which hospitals establish group incentives for their nonemployee physicians to control spending on highly-priced drugs and devices. We find that gainsharing lowered hospitals’ spending on devices, and this occurred from both greater negotiating power and standardizing purchasing on lower-priced items. The model describes the conditions under which each of these outcomes is achieved. We also find that the incentives had the greatest effect on groups that were most costly and least standardized prior to gainsharing. However, we do not find evidence of differences by group size,...
Journal of Population Economics, 2009
Several papers have tested the empirical validity of the migration models proposed by and . Howev... more Several papers have tested the empirical validity of the migration models proposed by and . However, to our knowledge, none has been able to disentangle the separate impact of observable and unobservable individual characteristics, and their respective returns across different locations, on an individual's decision to migrate. We build a model in which individuals sort, in part, on potential earningswhere earnings across different locations are a function of both observable and unobservable characteristics. We focus on the inter-provincial migration patterns of Canadian physicians. We choose this particular group for several reasons including the fact that they are paid on a fee-for-service basis. Since wage rates are exogenous, earning differentials are driven by differences in productivity. We then estimate a mixed conditional-logit model to determine the effects of individual and destination-specific characteristics (particularly earnings differentials) on physician location decisions. We find, among other things, that high-productivity physicians (based on unobservables) are more likely to migrate to provinces where the productivity premium is greater, while low-productivity physicians are more likely to migrate to areas where the productivity premium is lower. These results are consistent with a modified Borjas model of self-selection in migration based on both unobservables and observables. JEL Classification: J24, J61, C23, C35
Journal of Health Economics, 2011
In this paper, we propose a theoretical model where health can evolve over time and where GPs di¤... more In this paper, we propose a theoretical model where health can evolve over time and where GPs di¤er in their diagnosis ability and level of altruism. In our model, certain types of illnesses, which may or may not require specialty care, are assumed to be diagnosed with potential error -where the diagnostic precision depends on the GPs diagnostic ability. Finally, we assume that certain types of illnesses may worsen over time if they are not treated with appropriate care. We solve for the GP's treatment and referral decisions which maximize the patient's expected utility (subject to GPs' and Specialists'participation constraints) as a function of the GP's diagnostic ability (what we call the First-Best outcome). We then consider three common types of physician payment mechanisms: fee-for-service, capitation and fundholding. For each, we derive the GPs' utility maximizing treatment and referral decisions as a function of their diagnostic and altruism level. For each payment mechanism we compare the treatment and referral decisions of di¤erent types of physicians to those derived under the First-Best. Finally, we examine GPs'behaviour across di¤erent types of payment mechanisms in order to identify which one yields the best outcomes (in utility terms).
Journal of Economics & Management Strategy, 2009
We examine provider and patient behavior in a dynamic model where effort is noncontractible, comp... more We examine provider and patient behavior in a dynamic model where effort is noncontractible, competition between providers is modeled in an explicit way and where patients' outside options are solved for in equilibrium. Physicians are characterized by an individual-specific ethical constraint which allows for unobserved heterogeneity. This introduces uncertainty in the patient's expected treatment if he were to leave his current physician to seek care elsewhere. We also introduce switching costs and uncertainty in the treatment-outcome relationship. Our model generates equilibria with treatment heterogeneity, unstable physician-patient relationships, and overtreatment (a form of defensive medicine).
Journal of Computing in Civil Engineering, 1991
ABSTRACT Specialized computer‐aided education tools are necessary to provide a transition between... more ABSTRACT Specialized computer‐aided education tools are necessary to provide a transition between theoretical formulations of matrix methods of structural dynamic computations and the fully automated analysis procedures found in general‐purpose analysis packages. This paper presents an interactive computer graphics program, CAL/CGI, that has been developed to represent the relationship between each stage of the formulation, solution, and interpretation of linear static and dynamic structural analysis problems. A modified version of the CAL program, an educational tool for computer‐assisted learning of structural analysis, is used to produce user‐defined matrices that can be visually interpreted by CAL/CGI. A brief overview of CAL and a description of the capabilities of the CAL/CGI module are presented and illustrated using simple examples.
Health Economics, 2005
HEC), Montréal. Tous droits réservés pour tous pays. Toute traduction ou toute reproduction sous ... more HEC), Montréal. Tous droits réservés pour tous pays. Toute traduction ou toute reproduction sous quelque forme que ce soit est interdite. Les textes publiés dans la série des Cahiers de recherche HEC n'engagent que la responsabilité de leurs auteurs. La publication de ce Cahier de recherche a été rendue possible grâce à des subventions d'aide à la publication et à la diffusion de la recherche provenant des fonds de l'École des HEC. Direction de la recherche, École des HEC, 3000, chemin de la Côte-Sainte-Catherine, Montréal (Québec) Canada H3T 2A7.
Engineering Structures, 1994
ABSTRACT
Engineering Structures, 2005
A theoretical model is developed for transient water pressure variations along a tensile seismic ... more A theoretical model is developed for transient water pressure variations along a tensile seismic concrete crack with known crack wall motion history. Experimental tests are performed to validate the proposed model. Experimental and numerical results show that water can penetrate into new seismic cracks making them partially saturated over a length L sat . The magnitude of L sat and the total water uplift force acting on a crack wall are decreased by crack opening and increased by crack closing. The model is then implemented in a nonlinear discrete crack finite element program for seismic analysis of concrete dams. A 90 m high gravity dam subjected to two different ground accelerations is analysed. The magnitude of uplift force in the opening mode of the crack is small such that the downstream sliding safety factor (SSF) during crack opening is similar to the SSF assuming zero uplift force in the crack. Although the transient uplift force during crack closing reduces the upstream SSF, compared to a similar value assuming zero uplift force in the crack, its magnitude still remains larger than the minimum downstream SSF corresponding to the crack opening mode.
Computers & Structures, 1990
There is currently a lack of specialized educational software for the teaching of matrix structur... more There is currently a lack of specialized educational software for the teaching of matrix structural analysis. Presented are the development and application of an interactive computer graphics program, CAL/CGI, to complement an enhanced version of the CAL program which has been used extensively for teaching matrix structura1 analysis. The basic commands of the CALjCGI program are summarized and its application to support the understanding of the theory of the direct stiffness method is illustrated using simple examples
In many health%care systems, individuals are fully insured but often face long waiting times. Alt... more In many health%care systems, individuals are fully insured but often face long waiting times. Although the introduction of a private sector may allow individuals to avoid long waiting times, care can be very ex% pensive. In this paper, we build a model where patients may ...