AMU - AMSE
5-9 Boulevard Maurice Bourdet, CS 50498
13205 Marseille Cedex 1
Ventelou
Bruno Ventelou
Faculty
,
CNRS
Status
Research professor
Research fields
Health economics
Macroeconomics
Thesis
1995
,
Paris School of Economics, EHESS
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Contact
bruno.ventelou[at]univ-amu.fr
+33(0)4 13 55 25 82
Address
Îlot Bernard du Bois
Publications
Flux internationaux d'aide à la santé, taux de mortalité adulte et PIB. Le "triangle d'or" du développement ?Journal article, Revue Tiers-Monde, Volume 215, Issue 3, pp. 93-110, 2013
The study examines the triangular relationship between adult mortality, per capita income and foreign aid. Data are taken from the 'Institute for Health Metrics and Evaluation'. We have included 37 low-income (LIC), 39 lower middle-income (LMIC), and 20 upper middle income (UMIC) for the period 1990-2008. The study starts from the idea that the statistical relationship between series of foreign aid and population health may be bidirectional, adding a new stage of complexity for testing the impact of a third variable : GDP, which could also predetermine the levels of aid granted. The Granger causality test is the most effective and practical way to determine the direction of the causalities. Although less effective for particular groups of countries (UMIC), foreign aid generally has a negative impact on mortality, as reported by tests taking into account directional causalities (70 % of valid coefficients are negative). This result moderates the pessimistic view of international development aid, at least in the domain of assistance for health.
Drug-specific quality indicators assessing outpatient antibiotic use among French general practitioners.Journal article, European Journal of Public Health, Volume 23, Issue 2, pp. 262-264, 2013
Quality indicators assessing the use of antibiotics among general practitioners (GPs) would be useful to target antibiotic stewardship interventions. We adapted to an individual GP level a set of 12 drug-specific quality indicators of outpatient antibiotic use in Europe developed by the European surveillance of antimicrobial consumption project. We performed a cross-sectional study analysing reimbursement data on outpatient antibiotic prescriptions in adults in south-eastern France in 2009. Substantial heterogeneity in antibiotic prescribing among French GPs was observed, and opportunity to improve antibiotic prescribing can be identified.
Approaching the quality of antibiotic prescriptions in primary care using reimbursement data.Journal article, European Journal of Clinical Microbiology & Infectious Diseases, Volume 32, Issue 3, pp. 325-332, 2013
Our objectives for this investigation were: (i) to design quality measures of outpatient antibiotic use that could be calculated at the individual general practitioner (GP) level using reimbursement data only; and (ii) to analyse the variability in antibiotic prescriptions between GPs regarding these measures in south-eastern France. Based on the literature and international therapeutic guidelines, we designed a set of quality measures in an exploratory attempt to assess the quality of antibiotic prescriptions. We performed a cross-sectional study of antibiotic prescriptions in adults in south-eastern France in 2009, using data from the outpatient reimbursement database of the French National Health Insurance (NHI). We carried out a cluster analysis to group GPs according to their antibiotic prescribing behaviour. Six quality measures were calculated at the GP level, with wide variations in practice regarding all these measures. A six-cluster solution was identified, with one cluster grouping 56 % of the sample and made up of GPs having the most homogeneous pattern of prescription for all six quality measures, probably reflecting better antibiotic prescribing. Total pharmaceutical expenses (per patient), penicillin combinations use, quinolone use and seasonal variation of quinolone use were all positively associated with a more heterogeneous and possibly less appropriate use of antibiotics in a multivariate analysis. These quality measures could be useful to assess GPs' antibiotic prescribing behaviour in countries where no information system provides easy access to data linking drug use to a clinical condition.
Indicators show differences in antibiotic use between general practitioners and paediatricians.Journal article, European Journal of Clinical Microbiology & Infectious Diseases, Volume 32, Issue 7, pp. 929-935, 2013
The purpose of this investigation was to adapt to an individual physician level and to the paediatric context a set of drug-specific indicators of outpatient antibiotic use developed by the European Surveillance of Antimicrobial Consumption (ESAC) project, and to describe the differences in antibiotic prescriptions between general practitioners (GPs) and paediatricians. We conducted a retrospective cross-sectional study analysing antibiotic prescriptions in 2009 for children below 16 years of age in south-eastern France, using the National Health Insurance (NHI) outpatient reimbursement database. A generalised linear model adjusted on physicians' characteristics and patient population characteristics was used to compare indicators between GPs and paediatricians. We included 4,921 self-employed GPs and 301 paediatricians. Penicillins accounted for 47% and 45% of all antibiotics prescribed by GPs and paediatricians, respectively, followed by cephalosporins (33% and 39%) and macrolides (14% and 9%). In both specialties, there were around 70% more antibiotic prescriptions during the winter quarters compared to the summer quarters. The 13 indicators we calculated showed wide variations in antibiotic prescriptions among GPs, among paediatricians, and between GPs and paediatricians. In an adjusted econometric model, GPs were found to issue 54% more antibiotic prescriptions than paediatricians, whereas paediatricians used a significantly higher proportion of co-amoxiclav (18% vs. 12%) and cephalosporins (39% vs. 33%) and a significantly lower proportion of macrolides (9% vs. 14%) compared to GPs. A set of 13 indicators may be calculated using reimbursement data to describe outpatient antibiotic use at the physician level. We observed very different prescribing profiles between GPs and paediatricians.
Sex-based differences in income and response to proposed financial incentives among general practitioners in France.Journal article, Health Policy, Volume 113, Issue 1-2, pp. 199-205, 2013
Women represent a growing proportion of the physician workforce, worldwide. Therefore, for the purposes of workforce planning, it is increasingly important to understand differences in how male and female physicians work and might respond to financial incentives. A recent survey allowed us to determine whether sex-based differences in either physician income or responses to a hypothetical increase in reimbursement exist among French General Practitioners (GPs). Our analysis of 828 male and 244 female GPs' responses showed that females earned 35% less per year from medical practice than their male counterparts. After adjusting for the fact that female GPs had practiced medicine fewer years, worked 11% fewer hours per year, and spent more time with each consultation, female GPs earned 11,194euro, or 20.6%, less per year (95% CI: 7085euro-15,302euro less per year). Male GPs were more likely than female GPs to indicate that they would work fewer hours if consultation fees were to be increased. Our findings suggest that, as the feminization of medicine increases, the need to address gender-based income disparities increases and the tools that French policymakers use to regulate the physician supply might need to change.
Cross-sectional survey: risk-averse French GPs use more rapid-antigen diagnostic tests in tonsillitis in childrenJournal article, BMJ open, Volume 3, Issue 10, 2013
OBJECTIVES: We tested the following hypotheses: (1) risk-averse general practitioners (GPs) might use more Rapid Antigen Diagnostic Tests (RADTs) in tonsillitis in children, probably to decrease their diagnostic uncertainty regarding the aetiology of the disease (viral vs due to group A Streptococcus); and (2) GPs not using RADT might prescribe more antibiotics when they are risk averse. DESIGN, SETTING AND PARTICIPANTS: We conducted a cross-sectional survey of a nationwide French representative sample of 1093 GPs in 2012. OUTCOME MEASURES: Multivariate analyses adjusted on the four stratification variables (age, gender, location and volume of activity, ie, the number of annual consultations) were performed to identify the risk domains associated with indicators of good or poor practice. RESULTS: 69.4% of GPs were aware of national guidelines regarding tonsillitis and declared that they had taken these guidelines into account for their last paediatric tonsillitis case. 59.1% declared they used RADT in their last patient aged between 3 and 16 years presenting with tonsillitis; 29.7% of these tests were positive. Among the GPs who used RADT, 30.7% prescribed an antibiotic; 98.3% did either prescribe an antibiotic because of a positive RADT result, or did not prescribe an antibiotic in view of a negative result. Among the GPs who did not use RADT, 50.7% prescribed an antibiotic. In multivariate analyses, risk-averse GPs declared being more aware of and compliant with guidelines (OR=1.56, p<0.01), and used RADTs more often for their last patient (OR=1.30, p<0.05). Among GPs not using RADT in their last patient, risk-averse GPs prescribed more antibiotics compared with risk-tolerant doctors (OR=1.18, p<0.05). CONCLUSIONS: Individual risk attitudes influenced GPs' practices in tonsillitis, particularly the use of RADTs and antibiotic prescriptions.
The macroeconomic consequences of renouncing to universal access to antiretroviral treatment for HIV in Africa: a micro-simulation model.Journal article, PLoS ONE, Volume 7, Issue 4, pp. e34101, 2012
AIM: Previous economic literature on the cost-effectiveness of antiretroviral treatment (ART) programs has been mainly focused on the microeconomic consequences of alternative use of resources devoted to the fight against the HIV pandemic. We rather aim at forecasting the consequences of alternative scenarios for the macroeconomic performance of countries. METHODS: We used a micro-simulation model based on individuals aged 15-49 selected from nationally representative surveys (DHS for Cameroon, Tanzania and Swaziland) to compare alternative scenarios : 1-freezing of ART programs to current levels of access,
Une analyse microéconomique du gage patrimonial dans l'aide aux personnes dépendantesJournal article, Revue Économique, Volume 63, Issue 2, pp. 339-372, 2012
This paper examines the possible reform of the system of aid to dependent individuals (apa), a reform aimed at recovering the subsidies awarded from the individual?s bequest. We develop a theoretical model with a dependent parent and an offspring that can potentially act as informal carer. The parent decides how much formal aid to buy, while the offspring decides how much informal care to provide to her parent. The model is solved for three cases: no altruism, altruism from bequests (towards a surviving spouse or offspring), and altruism towards the parent. We show that recovering the subsidy from the bequest increases the amount of informal aid supplied by a non-altruist offspring, while the versions with altruism yield ambiguous results. Classification JEL : D11, D3
HIV/AIDS-GDP Nexus? Evidence from panel-data for African countriesJournal article, Economics Bulletin, Volume 32, Issue 1, pp. 1060-1067, 2012
To test potential bilateral causalities relation between HIV-AIDS mortality and GDP, we propose a simple Granger noncausality test for heterogeneous panel data models. 44 African countries are selected for annual pooled data from 1990 to 2009. Results are presented for the heterogeneous noncausality hypothesis (HENC), which tests, for each cross-section unit, the nullity of all the coefficients of the lagged explanatory variable. Bilateral causality relation is observed for 5 countries out of 44 (11% of the countries in our data set). We have 18 countries of unidirectional causality, which 14 are from HIV mortality rate to GDP (43% from total), and 4 are from GDP to HIV mortality rate (9% from total). These results alert for the risk of epidemic trap, initiated first by the deleterious effect of HIV-Aids on countries income.
Perceptions and attitudes of French general practitioners towards rapid antigen diagnostic tests in acute pharyngitis using a randomized case vignette studyJournal article, Journal of Antimicrobial Chemotherapy, Volume 67, Issue 6, pp. 1540-1546, 2012
Objectives This study had three objectives: (i) to assess the use of rapid antigen diagnostic tests (RADTs) and their impact on the antibiotic prescribing behaviour of general practitioners (GPs) for acute pharyngitis; (ii) to study the barriers to the use of RADTs; and (iii) to identify GPs' characteristics associated with non-compliance with French guidelines.Methods We conducted a cross-sectional survey of a representative sample of 369 self-employed GPs in south-eastern France using a randomized case vignette study.Results The availability of an RADT allowed a 44% relative reduction in the rate of antibiotic prescriptions. Of GPs for whom the test was available, 34% did not use an RADT in our acute pharyngitis vignette and 13% of those who used the test prescribed an antibiotic despite a negative RADT result. Non-compliance with French guidelines (i.e. not using an RADT and/or prescribing an antibiotic despite a negative RADT result) was independently associated with the following factors: less reading of medical journals, less benefits/risks discussion with patients about vaccinations and higher perception that clinical examination was sufficient to prescribe antibiotics. The three main declared barriers to RADT use were: time to perform the test, patient expectations regarding antibiotics and the perception that clinical examination was sufficient to decide to prescribe an antibiotic.Conclusions RADTs are a useful but not sufficient tool to reduce antibiotic prescribing in general practice. The results of this study increase understanding of the factors underlying clinical decision making for acute pharyngitis and may contribute to the development of interventions to improve practice.
