Research
Research
Quantifying and understanding imperfect take-up rates of French guaranteed minimum income and in-work benefit
Abstract : Imperfect take-up occurs when individuals do not receive all or part of the social benefits to which they are entitled. This is a widespread phenomenon around the world, with significant social and economic consequences. Accurately estimating the non-take-up rate, the share of eligible population who do not receive a given benefit, is particularly challenging. It requires observing, for the same population, both benefit claims and the administrative variables used to determine eligibility and calculate benefit amounts. By leveraging a variety of administrative and survey data, particularly a new administrative dataset on monthly fluctuations in primary and secondary income (Dispositif de ressources mensuelles, DRM), I re-estimate the take-up rate of France’s guaranteed minimum income (the Revenu de solidarité active, RSA) in 2021. I also provide, for the first time, an estimate of the non-take-up rate for France’s in-work benefit (the Prime d’activité). Then, I examine the different factors associated with the non-take-up of these two benefits among the French population.
Are low-income willing to pay more to remain insured? Evidence from subsidized complementary health insurance in France, with Benoît Carré
Abstract : This paper investigates the effect of a French benefit regulation policy on the enrollee's health insurance choices. Using a quasi-experimental design, we estimate the probability of renewing participation in a means-tested subsidized complementary health insurance (CHI) program following an increase in plan generosity. Enrollees face positive or negative premium variations depending on their age and past plan choices. While recent theoretical work suggests a negative expected impact of benefit regulation policies on insurance enrollment, empirical evidence remains limited. Our results reveal that healthier enrollees are less likely to remain in the program when their post-reform premiums increase. In contrast, sicker individuals are more likely to renew their participation regardless of premium changes.
Accounting for health preferences in the study of healthcare utilization, with Brigitte Dormont and Anne-Laure Samson
Abstract : A substantial body of economic literature seeks to disentangle the respective roles of healthcare needs and access barriers in shaping healthcare utilization. However, the relationship between individual heterogeneity in health preferences and healthcare utilization remains unexplored. Drawing on an original survey that directly elicits individuals’ valuation of health in the health–income trade-off, we revisit the classic question of the determinants of healthcare utilization. Specifically, we address two questions: How do health preferences help explain the utilization of general practitioners, specialists, and dentists? And do health preferences account for part of the well-established association between health status, socioeconomic status, and healthcare utilization? Our data, collected in 2009 from a representative sample of more than 3,000 French adults aged 18 or older, reveal heterogeneity in health preferences among individuals with similar health and socioeconomic status. Using multiple probit regression models, we find a limited but positive and significant association between the valuation of health in the health–income trade-off and healthcare utilization, ceteris paribus. Moreover, controlling for typically omitted health preferences does not alter the well-documented relationship between healthcare utilization, and socioeconomic status.
Households income month-to-month volatility, with Nicolas Paliod and Lauriane Ramuzat
Personal interdependence payment and social integration, with Doriane Mignon and Pulkit Singh
Cost-shifting or demand-inducing: how do french physicians react to the limit on fees charged to low-income patients?, with Brigitte Dormont
An older version of this article was published in a peer-reviewed journal : L’interdiction des dépassements d’honoraires pour les bénéficiaires de la CMU‑C : quelles conséquences pour les médecins et dentistes libéraux ?. Economie et Statistique / Economics and Statistics, 2021.
The finished version of this article is published as a Working paper.
Abstract : In France, a means-tested public programme offers free complementary health insurance (FCHI) to low-income individuals. However, this programme may lead to discrimination against FCHI beneficiaries due to fee limitations imposed on physicians and dentists for these patients. We examine the impact of admitting FCHI beneficiaries on the fees, earnings, and care volume provided by self-employed physicians and dentists. Our estimates are performed on longitudinal microeconomic data recording information at the physician level for years 2005, 2008, 2011, and 2014. Based on an instrumental variable estimator to address the non-exogeneity of FCHI patient share our findings reveal that accepting more FCHI beneficiaries results in a significant decrease in the average fee per visit or procedure, without compensatory fee increases for other patients. Moreover, caregivers who treat more FCHI beneficiaries tend to provide more care per patient. Overall, the fee ceiling for FCHI beneficiaries does not significantly affect the earnings of physicians and dentists, whereas it potentially provides incentives to supply-induced demand behavior.