39th French Health Economists Days : IntroductionJournal articleCarine Franc, Alain Paraponaris and Bruno Ventelou, Revue d'économie politique, Volume 129, Issue 4, pp. 441-445, 2019


Epidemiological Transition and the Wealth of Nations: the Case of HIV/AIDS in a Microsimulation ModelJournal articleYves Arrighi and Bruno Ventelou, Revue d'économie politique, Volume 129, Issue 4, pp. 591-618, 2019

This paper aims at quantifying the effect of healthcare programs on economic outcomes in the context of developing countries experiencing epidemiological transitions. It is widely accepted in the literature that treatment programs result in production gains among ill-health workers. However, these programs have the additional effect of modifying both the size and the composition of the working population by increasing the proportion of chronically-ill individuals. First, we define the theoretical conditions under which this macro-epidemiological phenomenon outweighs the positive effect of an increase in production. Second, we decompose the economic consequences of access to antiretroviral treatments against HIV in three sub-Saharan African countries. Forecasts of an individual’s health status, depending on whether he or she has access to medication, are generated using a microsimulation model. We use the model to generate a counterfactual (as if the adverse epidemiological effect did not exist), which allows decomposing the total impact of the HIV-medicines program into two different effects: positive and negative. We find that the positive effect of treatment procurement outweighs the negative epidemiological effect. Of course, this approach is only an indicator of economic performance and should in no way constitute a decision-making criterion about the ethical necessity of access to health care.

Prospective study on chronic diseases and healthcare costs for the south of France region, 2016-2028Journal articleBérengère Davin, Sébastien Cortaredona, Valérie Guagliardo, Stève Nauleau, Bruno Ventelou and Pierre Verger, European Journal of Public Health, Volume 29, Issue Supplement_4, 2019

In France, Health Regional Agencies (HRA) have to elaborate a Public Health Plan for the 5 coming years. For estimating future population health needs and associated costs to adapt the health services on the regional territory, the HRA in southeastern France requested a prospective analysis, based on demographic and epidemiologic scenarios about major chronic diseases, to evaluate future trends.

Six chronic diseases were selected: diabetes (1 or 2), cardiovascular diseases, respiratory diseases, cancers, neurological diseases and dementia. We used medico-administrative data from the National health insurance fund, and adapted algorithms to identify people with these diseases. We calculated prevalence rates according to gender and age and used two alternative scenarios (a constant one, and a trend-based one) to estimate the number of people with chronic diseases in 2023 and 2028, starting in 2016. We also estimated future healthcare costs according a constant and a trend-based scenario.

The algorithms detect reasonable rates of disease compared to official rates available for 2016. Due to demographic (ageing) and/or epidemiologic trends, the number of people with chronic diseases will highly increase during the next ten years in the South of France region. For instance, between 2016 and 2028, there will be from 15% to 20% more people with diabetes. Associated costs will also be higher (+33% between 2016 and 2028), especially those granted to nursing care (+40%).

Burden of diseases and health expenditures are going to increase in the future. Projections are needed to help policymakers anticipating the required health services adaptation. Medico-administrative database are an invaluable source of data to do so. The next step of this project will consist in estimating those trends for smaller geographical areas.

Child Income Appropriations as a Disease-Coping Mechanism: Consequences for the Health-Education RelationshipJournal articleRenaud Bourlès, Bruno Ventelou and Maame Esi Woode, The Journal of Development Studies, Volume 54, Issue 1, pp. 57-71, 2018

This paper analyses the relationships between HIV/AIDS and education taking into account the appropriative nature of child income. Using a theoretical model, we show that considering remittances from one’s child as an insurance asset can reverse the usual negative relationship between disease prevalence and educational investment. This prediction confirms the results of an empirical study conducted on data compiled from the Demographic and Health Survey (DHS) database for 12 sub-Sahara African countries for children aged between 7 and 22-years-old. Using regional HIV prevalence as a measure of health risk, we find that the ‘sign of the slope’ between health risk and the enrolment of children is not constant. Splitting the data based on expected remittance patterns (for example rural versus urban), we obtain that the effect is most likely driven by household characteristics related to child income appropriation.

Comparing GPs’ risk attitudes for their own health and for their patients’ : a troubling discrepancy?Journal articleAntoine Nebout, Marie Cavillon and Bruno Ventelou, BMC Health Services Research, Volume 18, Issue 1, pp. 283, 2018

In this paper, we report the results of risk attitudes elicitation of a French general practitioners national representative sample (N=1568).

Community Economic Distress and Changes in Medicare Patients' End-of-Life Care CostsJournal articleWilliam B. Weeks, Mariétou H. L. Ouayogodé, Bruno Ventelou, Todd Mackenzie and James N. Weinstein, Journal of Palliative Medicine, Volume 21, Issue 6, pp. 742-743, 2018

Real reductions in decedents’ per-capita Medicare fee-forservice
(FFS) spending accounted for most of Medicare’s
cost growth mitigation between 2009 and 2014.1 Decedents’
spending reductions immediately followed the Great Recession
of 2007–2009, which accounted for 14% of the decline
in overall Medicare spending growth between 2009 and
2012.2 Since Medicare patients living in lower income areas
spend more at the end of life (EOL),3 we sought to explore
whether local economic distress levels were associated with
decedents’ spending.

Predicting medical practices using various risk attitude measuresJournal articleSophie Massin, Antoine Nebout and Bruno Ventelou, The European Journal of Health Economics, Volume 19, Issue 6, pp. 843–860, 2018

This paper investigates the predictive power of several risk attitude measures on a series of medical practices. We elicit risk preferences on a sample of 1500 French general practitioners (GPs) using two different classes of tools: scales, which measure GPs’ own perception of their willingness to take risks between 0 and 10; and lotteries, which require GPs to choose between a safe and a risky option in a series of hypothetical situations. In addition to a daily life risk scale that measures a general risk attitude, risk taking is measured in different domains for each tool: financial matters, GPs’ own health, and patients’ health. We take advantage of the rare opportunity to combine these multiple risk attitude measures with a series of self-reported or administratively recorded medical practices. We successively test the predictive power of our seven risk attitude measures on eleven medical practices affecting the GPs’ own health or their patients’ health. We find that domain-specific measures are far better predictors than the general risk attitude measure. Neither of the two classes of tools (scales or lotteries) seems to perform indisputably better than the other, except when we concentrate on the only non-declarative practice (prescription of biological tests), for which the classic money-lottery test works well. From a public health perspective, appropriate measures of willingness to take risks may be used to make a quick, but efficient, profiling of GPs and target them with personalized communications, or interventions, aimed at improving practices.

Contribution à « Rareté » et « Biens et services de santé »Book chapterBruno Ventelou, In: Dictionnaire des Biens Communs, Marie Cornu, Fabienne Orsi and Judith Rochfeld (Eds.), 2017, PUF, 2017


L’informalité est-elle un choix ? Éléments de preuve à partir d’une évaluation contingente pour l’assurance sociale en TunisieJournal articleKhaled Makhloufi, Christel Protière and Bruno Ventelou, Journal de gestion et d'economie medicales, Volume 35, Issue 4-5, pp. 209-237, 2017

Dans plusieurs pays en développement et en particulier au Moyen-Orient et en Afrique du Nord, l’informalité est regardée comme une fatalité et laisse une proportion importante de la population non couverte par le système de sécurité sociale. Une enquête d’évaluation contingente a été menée en Tunisie en 2013, se proposant d’estimer les consentements à payer (CAP) pour deux régimes hypothétiques d’assurance volontaire : un régime d’assurance maladie géré par la ‘Caisse Nationale d’Assurance Maladie’ et un régime vieillesse géré par la ‘Caisse Nationale de Sécurité Sociale’.
L’échantillon se compose de 456 individus non couverts par un régime de sécurité sociale (maladie ou vieillesse), interrogés dans les régions Nord, Centre et Sud du pays. Les personnes interrogées ont été recrutées sur les marchés (souks) – caractérisés par la forte présence d’acteurs du secteur informel – et les places publiques (Al-mydan) – où s’organisaient régulièrement des rassemblements pacifiques de chômeurs pour revendiquer des droits sociaux peu après ce qui a été appelé ‘le printemps Arabe’ qui a débuté en Tunisie fin 2010.
L’intention d’adhésion déclarée par les travailleurs informels et les sans-emploi varie selon le type de filière de soins proposée et selon les risques couverts (avec ou sans assurance-vieillesse). Les résultats confirment les hypothèses selon lesquelles une affiliation volontaire à deux régimes d’assurance serait majoritairement acceptée par les non couverts et les CAPs déclarés pour cette affiliation seraient substantiels. Ils apportent donc des éléments de discussion en termes de politiques tunisiennes de santé (objectif de couverture santé universelle) et d’assurance-vieillesse.
Finalement, nos résultats montrent d’une part que l’informalité n’est pas un choix des individus et que le contrôle de l’évasion sociale en Tunisie est possible. D’autre part, la comparaison manifestants/non manifestants montre qu’il est possible de généraliser une offre d’assurance sociale au-delà du cercle restreint des « activistes ».

The value of specialist care—infectious disease specialist referrals—why and for whom? A retrospective cohort study in a French tertiary hospitalJournal articleManoj Sasikumar, Sylvie Boyer, Anne Remacle-Bonnet, Bruno Ventelou and Philippe Brouqui, European Journal of Clinical Microbiology & Infectious Diseases, Volume 36, Issue 4, pp. 625-633, 2017

This study evaluated the impact of infectious disease (ID) specialist referrals on outcomes in a tertiary hospital in France. This study tackled methodological constraints (selection bias, endogeneity) using instrumental variables (IV) methods in order to obtain a quasi-experimental design. In addition, we investigated whether certain characteristics of patients have a bearing on the impact of the intervention. We used the payments database and ID department files to obtain data for adults admitted with an ID diagnosis in the North Hospital, Marseille from 2012 to 2014. Comparable cohorts were obtained using coarsened exact matching and analysed using IV models. Mortality, readmissions, cost (payer perspective) and length of stay (LoS) were analysed. We recorded 15,393 (85.97%) stays, of which 2,159 (14.03%) benefited from IDP consultations. The intervention was seen to significantly lower the risk of inpatient mortality (marginal effect (M.E) = –19.06%) and cost of stay (average treatment effect (ATE) = – €5,573.39). The intervention group was seen to have a longer LoS (ATE = +4.95 days). The intervention conferred a higher reduction in mortality and cost for stays that experienced ICU care (mortality: odds ratio (OR) =0.09, M.E cost = –8,328.84 €) or had a higher severity of illness (mortality: OR=0.35, M.E cost = –1,331.92 €) and for patients aged between 50 and 65 years (mortality: OR=0.28, M.E cost = -874.78 €). This study shows that ID referrals are associated with lower risk of inpatient mortality and cost of stay, especially when targeted to certain subgroups.