C. Milcent - Academia.edu (original) (raw)
Papers by C. Milcent
The purpose of this paper is to study hospital cost variability in the event of introduction of a... more The purpose of this paper is to study hospital cost variability in the event of introduction of a Prospective Payment System (PPS) in France. In a previous paper, we considered heterogeneity between hospitals to be due to di¤erences in hospitals’ e¤orts to reduce costs, i.e. to moral hazard. In this paper, we use a new three dimensional database (stays-hospitals-years) to take into account adverse selection parameters that the regulator may be willing to integrate into the payment system. Econometric estimates are performed on a sample of 11,573 stays for acute myocardial infarction (AMI) observed in 44 French public hospitals over the period 1994 to 1997. Our estimation procedure allows us to identify adverse selection and moral hazard components of hospital cost variability. Moral hazard is far from negligible : its estimated standard error is about 50 % of the standard error we estimate for cost variability due to permanent heterogeneity between hospitals. Simulations show that a cost reduction of about 16 % can be expected from implementation of a payment system which allows for permanent unobserved heterogeneity and eliminates only moral hazard. Resume Cet article vise a etudier la variabilite des couts hospitaliers dans l’hypothese de l’introduction d’un systeme de tari...cation par pathologie dans le secteur public hospitalier francais. Dans un ¤Corrrespondence to : Thema UPX, Bâtiment G, 200 avenue de la republique 92001 Nanterre cedex, France. Tel : 00 33 1 40 97 78 36. Fax : 00 33 1 40 97 e-mail : dormont@u-paris10.fr
Annals of Economics and Statistics, 2016
Evaluating the Effect of Ownership Status on Hospital Quality: The Key Role of Innovative Procedu... more Evaluating the Effect of Ownership Status on Hospital Quality: The Key Role of Innovative Procedures * Mortality differences between university, non-teaching public and for-profit hospitals are investigated using a French exhaustive administrative dataset on patients admitted for heart attack. Our results show that innovative procedures play a key role in explaining the effect of ownership status on hospital quality. When age, sex, diagnoses and co-morbidities are held constant, the mortality rates in for-profit and university hospitals are similar, but they are lower than in public non-teaching hospitals. When additionally controlling for innovative procedures, the mortality rate is higher in for-profit hospitals than in the two groups of public hospitals. This suggests that the quality of care in for-profit hospitals relies on innovative procedures and that, after controlling for case-mix and innovative treatments, there is a better quality of care in public hospitals.
Journal of Health Economics, 2011
Any opinions expressed here are those of the author(s) and not those of IZA. Research published i... more Any opinions expressed here are those of the author(s) and not those of IZA. Research published in this series may include views on policy, but the institute itself takes no institutional policy positions. The Institute for the Study of Labor (IZA) in Bonn is a local and virtual international research center and a place of communication between science, politics and business. IZA is an independent nonprofit organization supported by Deutsche Post Foundation. The center is associated with the University of Bonn and offers a stimulating research environment through its international network, workshops and conferences, data service, project support, research visits and doctoral program. IZA engages in (i) original and internationally competitive research in all fields of labor economics, (ii) development of policy concepts, and (iii) dissemination of research results and concepts to the interested public. IZA Discussion Papers often represent preliminary work and are circulated to encourage discussion. Citation of such a paper should account for its provisional character. A revised version may be available directly from the author.
The role of innovative procedures in the mortality gap between public and for-profit hospitals is... more The role of innovative procedures in the mortality gap between public and for-profit hospitals isinvestigated using a French exhaustive administrative dataset on patients admitted for heartattack. The more intensive use of innovative procedures by for-profit hospitals contributes largelyto explaining the mortality gap. Public hospitals are found to perform better than for-profithospitals when controlling for both the use of innovative procedures and patients' characteristics.
pse.ens.fr
No Brasil, apesar da participação no sistema educacional ser obrigatória para as crianças entre 7... more No Brasil, apesar da participação no sistema educacional ser obrigatória para as crianças entre 7 e 14 anos de idade, algumas não estão matriculadas na escola. Uma das principais razões é a sua inserção no mercado de trabalho que pode, conseqüentemente, ter um impacto na sua saúde. Escolas públicas no Brasil usualmente oferecem merenda e mais, crianças que trabalham às vezes cumprem dupla jornada: trabalham e estudam. O estado de saúde da criança pode estar sendo afetado pela participação ou não na escola e no mercado de trabalho. Problemas na freqüência escolar e no progresso educacional podem estar relacionados ao trabalho infantil e ao estado de saúde da criança. Desta forma, não podemos investigar esses três aspectos da vida da criança sem considerar as suas várias inter-relações. Neste artigo, usamos a Pesquisa de Padrões de Vida de 1996/1997 (PPV/IBGE) para mostrar essas interações, Trabalho infantil e freqüência escolar têm uma forte correlação. A freqüência escolar tem um impacto negativo na probabilidade da criança participar do mercado de trabalho. A participação da criança no mercado de trabalho afeta negativamente a probabilidade da criança avaliar bem a sua saúde. A principal conclusão do artigo é que uma política de desenvolvimento do capital humano deve considerar ambos os aspectos: saúde e educação. Uma política focada apenas em educação, como incentivos em ir à escola, tem efeito positivo na redução do trabalho infantil, mas não parece suficiente para melhorar a saúde das crianças. Na elaboração de políticas, o governo deve focar na população em risco social, crianças de famílias pobres, morando em piores condições e obrigadas a se inserirem no mercado de trabalho.
Journal of Economic Geography, 2013
Spatial Disparities in Hospital Performance * Using a French exhaustive dataset, this paper studi... more Spatial Disparities in Hospital Performance * Using a French exhaustive dataset, this paper studies the determinants of regional disparities in mortality for patients admitted to hospitals for a heart attack. These disparities are large, with an 80% difference in the propensity to die within 15 days between extreme regions. They may reflect spatial differences in patient characteristics, treatments, hospital characteristics, and local healthcare market structure. To distinguish between these factors, we estimate a flexible duration model. The estimated model is aggregated at the regional level and a spatial variance analysis is conducted. We find that spatial differences in the use of innovative treatments play a major role whereas the local composition of hospitals by ownership does not have any noticeable effect. Moreover, the higher the local concentration of patients in a few large hospitals rather than many small ones, the lower the mortality. Regional unobserved effects account for around 20% of spatial disparities.
This paper studies the determinants of the regional disparities in the mortality of patients trea... more This paper studies the determinants of the regional disparities in the mortality of patients treated in a hospital for a heart attack in France. These determinants can be some di¤erences in patient characteristics, treatments, hospital charateristics, and local healthcare market structure. We assess their importance with an exhaustive administrative dataset over the 1998-2003 period using a strati…ed duration model. The raw disparities in the propensity to die within 15 days between the extreme regions reaches 80%. It decreases to 47% after controlling for the patient characteristics and their treatments. In fact, a variance analysis shows that innovative treatments play an important role. Remaining regional disparities are signi…cantly related to the local healthcare market structure. The more patients are locally concentrated in a few large hospitals rather than many small ones, the lower the mortality.
Revue d'Economie Politique, 2000
Résumé Cet article vise à évaluer les effets potentiels, sur les dépenses publiques hospitalières... more Résumé Cet article vise à évaluer les effets potentiels, sur les dépenses publiques hospitalières françaises, de l'introduction d'une tarification par pathologie calculée sur le principe de la concurrence par comparaison (Shleifer (1985)). Les évaluations empiriques ...
The role of innovative procedures in the mortality gap between public and for-profit hospitals is... more The role of innovative procedures in the mortality gap between public and for-profit hospitals isinvestigated using a French exhaustive administrative dataset on patients admitted for heartattack. The more intensive use of innovative procedures by for-profit hospitals contributes largelyto explaining the mortality gap. Public hospitals are found to perform better than for-profithospitals when controlling for both the use of innovative procedures and patients' characteristics.
Journal of Economic Geography, 2013
Les documents de travail ne reflètent pas la position de l'INSEE et n'engagent que leurs auteurs.
Health Economics, 2006
This paper tests for income-related reporting heterogeneity in selfassessed health (SAH). It also... more This paper tests for income-related reporting heterogeneity in selfassessed health (SAH). It also constructs a synthetic measure of clinical health to decompose the effect of income on SAH into an effect on clinical health (which is called a health production effect) and a reporting heterogeneity effect. We find health production effects essentially for lowincome individuals, and reporting heterogeneity for the choice between the medium labels i.e. "fair" vs. "good" and for high-income individuals. As such, SAH should be used cautiously for the assessment of incomerelated health inequalities in France. It is however possible to minimize the reporting heterogeneity bias by converting SAH into a binary variable for poor health versus other health statuses. * We would like to thank
Circulation, 2007
Women with acute myocardial infarction have a higher hospital mortality rate than men. This diffe... more Women with acute myocardial infarction have a higher hospital mortality rate than men. This difference has been ascribed to their older age, more frequent comorbidities, and less frequent use of revascularization. The aim of this study is to assess these factors in relation to excess mortality in women. All hospital admissions in France with a discharge diagnosis of acute myocardial infarction were extracted from the national payment database. Logistic regression on mortality was performed for age, comorbidities, and coronary interventions. Nonparametric microsimulation models estimated the percutaneous coronary intervention and mortality rates that women would experience if they were "treated like men." Data were analyzed from 74,389 patients hospitalized with acute myocardial infarction, 30.0% of whom were women. Women were older (75 versus 63 years of age; P<0.001) and had a higher rate of hospital mortality (14.8% versus 6.1%; P<0.0001) than men. Percutaneous coronary interventions were more frequent in men (7.4% versus 4.8%; 24.4% versus 14.2% with stent; P<0.001). Mortality adjusted for age and comorbidities was higher in women (P<0.001), with an excess adjusted absolute mortality of 1.95%. Simulation models related 0.46% of this excess to reduced use of procedures. Survival benefit related to percutaneous coronary intervention was lower among women. The difference in mortality rate between men and women with acute myocardial infarction is due largely to the different age structure of these populations. However, age-adjusted hospital mortality was higher for women and was associated with a lower rate of percutaneous coronary intervention. Simulations suggest that women would derive benefit from more frequent use of percutaneous coronary intervention, although these procedures appear less protective in women than in men.
This paper studies the determinants of the regional disparities in the mortality of patients trea... more This paper studies the determinants of the regional disparities in the mortality of patients treated in a hospital for a heart attack in France. These determinants can be some di¤erences in patient characteristics, treatments, hospital charateristics, and local healthcare market structure. We assess their importance with an exhaustive administrative dataset over the 1998-2003 period using a strati…ed duration model. The raw disparities in the propensity to die within 15 days between the extreme regions reaches 80%. It decreases to 47% after controlling for the patient characteristics and their treatments. In fact, a variance analysis shows that innovative treatments play an important role. Remaining regional disparities are signi…cantly related to the local healthcare market structure. The more patients are locally concentrated in a few large hospitals rather than many small ones, the lower the mortality.
The purpose of this paper is to study hospital cost variability in the event of introduction of a... more The purpose of this paper is to study hospital cost variability in the event of introduction of a Prospective Payment System (PPS) in France. In a previous paper, we considered heterogeneity between hospitals to be due to di¤erences in hospitals’ e¤orts to reduce costs, i.e. to moral hazard. In this paper, we use a new three dimensional database (stays-hospitals-years) to take into account adverse selection parameters that the regulator may be willing to integrate into the payment system. Econometric estimates are performed on a sample of 11,573 stays for acute myocardial infarction (AMI) observed in 44 French public hospitals over the period 1994 to 1997. Our estimation procedure allows us to identify adverse selection and moral hazard components of hospital cost variability. Moral hazard is far from negligible : its estimated standard error is about 50 % of the standard error we estimate for cost variability due to permanent heterogeneity between hospitals. Simulations show that a cost reduction of about 16 % can be expected from implementation of a payment system which allows for permanent unobserved heterogeneity and eliminates only moral hazard. Resume Cet article vise a etudier la variabilite des couts hospitaliers dans l’hypothese de l’introduction d’un systeme de tari...cation par pathologie dans le secteur public hospitalier francais. Dans un ¤Corrrespondence to : Thema UPX, Bâtiment G, 200 avenue de la republique 92001 Nanterre cedex, France. Tel : 00 33 1 40 97 78 36. Fax : 00 33 1 40 97 e-mail : dormont@u-paris10.fr
Annals of Economics and Statistics, 2016
Evaluating the Effect of Ownership Status on Hospital Quality: The Key Role of Innovative Procedu... more Evaluating the Effect of Ownership Status on Hospital Quality: The Key Role of Innovative Procedures * Mortality differences between university, non-teaching public and for-profit hospitals are investigated using a French exhaustive administrative dataset on patients admitted for heart attack. Our results show that innovative procedures play a key role in explaining the effect of ownership status on hospital quality. When age, sex, diagnoses and co-morbidities are held constant, the mortality rates in for-profit and university hospitals are similar, but they are lower than in public non-teaching hospitals. When additionally controlling for innovative procedures, the mortality rate is higher in for-profit hospitals than in the two groups of public hospitals. This suggests that the quality of care in for-profit hospitals relies on innovative procedures and that, after controlling for case-mix and innovative treatments, there is a better quality of care in public hospitals.
Journal of Health Economics, 2011
Any opinions expressed here are those of the author(s) and not those of IZA. Research published i... more Any opinions expressed here are those of the author(s) and not those of IZA. Research published in this series may include views on policy, but the institute itself takes no institutional policy positions. The Institute for the Study of Labor (IZA) in Bonn is a local and virtual international research center and a place of communication between science, politics and business. IZA is an independent nonprofit organization supported by Deutsche Post Foundation. The center is associated with the University of Bonn and offers a stimulating research environment through its international network, workshops and conferences, data service, project support, research visits and doctoral program. IZA engages in (i) original and internationally competitive research in all fields of labor economics, (ii) development of policy concepts, and (iii) dissemination of research results and concepts to the interested public. IZA Discussion Papers often represent preliminary work and are circulated to encourage discussion. Citation of such a paper should account for its provisional character. A revised version may be available directly from the author.
The role of innovative procedures in the mortality gap between public and for-profit hospitals is... more The role of innovative procedures in the mortality gap between public and for-profit hospitals isinvestigated using a French exhaustive administrative dataset on patients admitted for heartattack. The more intensive use of innovative procedures by for-profit hospitals contributes largelyto explaining the mortality gap. Public hospitals are found to perform better than for-profithospitals when controlling for both the use of innovative procedures and patients' characteristics.
pse.ens.fr
No Brasil, apesar da participação no sistema educacional ser obrigatória para as crianças entre 7... more No Brasil, apesar da participação no sistema educacional ser obrigatória para as crianças entre 7 e 14 anos de idade, algumas não estão matriculadas na escola. Uma das principais razões é a sua inserção no mercado de trabalho que pode, conseqüentemente, ter um impacto na sua saúde. Escolas públicas no Brasil usualmente oferecem merenda e mais, crianças que trabalham às vezes cumprem dupla jornada: trabalham e estudam. O estado de saúde da criança pode estar sendo afetado pela participação ou não na escola e no mercado de trabalho. Problemas na freqüência escolar e no progresso educacional podem estar relacionados ao trabalho infantil e ao estado de saúde da criança. Desta forma, não podemos investigar esses três aspectos da vida da criança sem considerar as suas várias inter-relações. Neste artigo, usamos a Pesquisa de Padrões de Vida de 1996/1997 (PPV/IBGE) para mostrar essas interações, Trabalho infantil e freqüência escolar têm uma forte correlação. A freqüência escolar tem um impacto negativo na probabilidade da criança participar do mercado de trabalho. A participação da criança no mercado de trabalho afeta negativamente a probabilidade da criança avaliar bem a sua saúde. A principal conclusão do artigo é que uma política de desenvolvimento do capital humano deve considerar ambos os aspectos: saúde e educação. Uma política focada apenas em educação, como incentivos em ir à escola, tem efeito positivo na redução do trabalho infantil, mas não parece suficiente para melhorar a saúde das crianças. Na elaboração de políticas, o governo deve focar na população em risco social, crianças de famílias pobres, morando em piores condições e obrigadas a se inserirem no mercado de trabalho.
Journal of Economic Geography, 2013
Spatial Disparities in Hospital Performance * Using a French exhaustive dataset, this paper studi... more Spatial Disparities in Hospital Performance * Using a French exhaustive dataset, this paper studies the determinants of regional disparities in mortality for patients admitted to hospitals for a heart attack. These disparities are large, with an 80% difference in the propensity to die within 15 days between extreme regions. They may reflect spatial differences in patient characteristics, treatments, hospital characteristics, and local healthcare market structure. To distinguish between these factors, we estimate a flexible duration model. The estimated model is aggregated at the regional level and a spatial variance analysis is conducted. We find that spatial differences in the use of innovative treatments play a major role whereas the local composition of hospitals by ownership does not have any noticeable effect. Moreover, the higher the local concentration of patients in a few large hospitals rather than many small ones, the lower the mortality. Regional unobserved effects account for around 20% of spatial disparities.
This paper studies the determinants of the regional disparities in the mortality of patients trea... more This paper studies the determinants of the regional disparities in the mortality of patients treated in a hospital for a heart attack in France. These determinants can be some di¤erences in patient characteristics, treatments, hospital charateristics, and local healthcare market structure. We assess their importance with an exhaustive administrative dataset over the 1998-2003 period using a strati…ed duration model. The raw disparities in the propensity to die within 15 days between the extreme regions reaches 80%. It decreases to 47% after controlling for the patient characteristics and their treatments. In fact, a variance analysis shows that innovative treatments play an important role. Remaining regional disparities are signi…cantly related to the local healthcare market structure. The more patients are locally concentrated in a few large hospitals rather than many small ones, the lower the mortality.
Revue d'Economie Politique, 2000
Résumé Cet article vise à évaluer les effets potentiels, sur les dépenses publiques hospitalières... more Résumé Cet article vise à évaluer les effets potentiels, sur les dépenses publiques hospitalières françaises, de l'introduction d'une tarification par pathologie calculée sur le principe de la concurrence par comparaison (Shleifer (1985)). Les évaluations empiriques ...
The role of innovative procedures in the mortality gap between public and for-profit hospitals is... more The role of innovative procedures in the mortality gap between public and for-profit hospitals isinvestigated using a French exhaustive administrative dataset on patients admitted for heartattack. The more intensive use of innovative procedures by for-profit hospitals contributes largelyto explaining the mortality gap. Public hospitals are found to perform better than for-profithospitals when controlling for both the use of innovative procedures and patients' characteristics.
Journal of Economic Geography, 2013
Les documents de travail ne reflètent pas la position de l'INSEE et n'engagent que leurs auteurs.
Health Economics, 2006
This paper tests for income-related reporting heterogeneity in selfassessed health (SAH). It also... more This paper tests for income-related reporting heterogeneity in selfassessed health (SAH). It also constructs a synthetic measure of clinical health to decompose the effect of income on SAH into an effect on clinical health (which is called a health production effect) and a reporting heterogeneity effect. We find health production effects essentially for lowincome individuals, and reporting heterogeneity for the choice between the medium labels i.e. "fair" vs. "good" and for high-income individuals. As such, SAH should be used cautiously for the assessment of incomerelated health inequalities in France. It is however possible to minimize the reporting heterogeneity bias by converting SAH into a binary variable for poor health versus other health statuses. * We would like to thank
Circulation, 2007
Women with acute myocardial infarction have a higher hospital mortality rate than men. This diffe... more Women with acute myocardial infarction have a higher hospital mortality rate than men. This difference has been ascribed to their older age, more frequent comorbidities, and less frequent use of revascularization. The aim of this study is to assess these factors in relation to excess mortality in women. All hospital admissions in France with a discharge diagnosis of acute myocardial infarction were extracted from the national payment database. Logistic regression on mortality was performed for age, comorbidities, and coronary interventions. Nonparametric microsimulation models estimated the percutaneous coronary intervention and mortality rates that women would experience if they were "treated like men." Data were analyzed from 74,389 patients hospitalized with acute myocardial infarction, 30.0% of whom were women. Women were older (75 versus 63 years of age; P<0.001) and had a higher rate of hospital mortality (14.8% versus 6.1%; P<0.0001) than men. Percutaneous coronary interventions were more frequent in men (7.4% versus 4.8%; 24.4% versus 14.2% with stent; P<0.001). Mortality adjusted for age and comorbidities was higher in women (P<0.001), with an excess adjusted absolute mortality of 1.95%. Simulation models related 0.46% of this excess to reduced use of procedures. Survival benefit related to percutaneous coronary intervention was lower among women. The difference in mortality rate between men and women with acute myocardial infarction is due largely to the different age structure of these populations. However, age-adjusted hospital mortality was higher for women and was associated with a lower rate of percutaneous coronary intervention. Simulations suggest that women would derive benefit from more frequent use of percutaneous coronary intervention, although these procedures appear less protective in women than in men.
This paper studies the determinants of the regional disparities in the mortality of patients trea... more This paper studies the determinants of the regional disparities in the mortality of patients treated in a hospital for a heart attack in France. These determinants can be some di¤erences in patient characteristics, treatments, hospital charateristics, and local healthcare market structure. We assess their importance with an exhaustive administrative dataset over the 1998-2003 period using a strati…ed duration model. The raw disparities in the propensity to die within 15 days between the extreme regions reaches 80%. It decreases to 47% after controlling for the patient characteristics and their treatments. In fact, a variance analysis shows that innovative treatments play an important role. Remaining regional disparities are signi…cantly related to the local healthcare market structure. The more patients are locally concentrated in a few large hospitals rather than many small ones, the lower the mortality.