ANR JCJC (2024-2027)
Healthcare needs in France are expected to grow in the next few decades. Aging population, an increase in diseases due to sedentary and poor health behavior (France is one of the European countries with the highest alcohol and tobacco consumption), a shortage of doctors, and the growth of treatment costs associated with innovation are expected to put pressure on the rise of healthcare expenditure. These major issues require a better understanding of how and why healthcare expenditure (HCE) evolves to better anticipate future healthcare needs. Evidence from foreign countries are hardly transposable to the French case, and little is known about the factors of HCE growth in France. Moreover, how these growth factors vary across time is still unknown. The factors driving HCE growth most of the time let aside the role of supply and demand. Thus, little is known, for example, about the impact of doctor shortage on HCE; whether telemedicine addresses medical desert issues; or how public policies can affect HCE.
DynamicsHealth aims to take advantage of the French administrative data that covers exhaustively every health care use for all French residents, to develop a pioneer and comprehensive analysis of how HCE evolves in France and to explain the reasons for these changes on the supply and demand sides. The main objectives are to: (i) describe the evolution of care over 16 years and understand the role of aging, technology, morbidity, and economic factors; (ii) identify the causal impact of supply variation on HCE. I will focus on the closure of doctors' practices and the arrival of new types of supply, such as telemedicine. (iii) Understand how public policies can modify the demand for healthcare by other levers than price. The role of having access to care through or under an insured (child under his parent and spouse under his wife) will be of particular interest because it highlights the role of confidentiality rules on healthcare demand.
Job offers on this contract:
Research assistant: 1 year, reconducted for 1 or 2 years, PhD grant opportunity. More information here.
Post doctoral position
Horizon grant (2023-2027)
Join with: Max Planck Institute & Munich Research Institute for the Economic of Ageing; Bruegel; University Carlos III Madrid; Royal Institution for the Advancement of Learning McGill University;
The baby boomers are in the process of retiring. Most are between 60 and 65 when they retire and almost 80% self-assess their health as good. A huge number of research projects has analyzed retirement decisions and the impact of this “pension wave” on the transformation of pension systems in the ageing societies in Europe and elsewhere. There is no lack of pension finance projections and policy advice for pension reforms and their socio-economic effects, including active ageing and the role of elder citizens in transforming our economies into “silver economies”.
Much less is known about the second great transformation that will follow the pension wave. In the mid2030s, the health of the baby boomers will have deteriorated and many in these large cohorts will be in need of formal and/or informal long-term care. This “care wave” will transform two generations: the baby boomers in need of care and their children who may supply care. It will have significant implications for labour supply, especially for women, saving behaviour, and therefore for productivity, economic growth and its inclusiveness.
The overarching objective of BB-Future is to make a concerted effort to understand the size and the implications of the care wave on economic and social outcomes, to appreciate the quality of this second ageing-related transformation and to develop policy recommendations for advance planning on the EU and MS levels.
More information on the project here.
Job offers on this contract:
Research assistant: 1 year, reconducted for 1 or 2 years, PhD grant opportunity.
Post doctoral position
"Impact of Physician Practice Closure on Patients' Healthcare access and use" with Daniel Herrera and Thibaut Heyer
Abstract: Physician practice closures can disrupt healthcare access and utilization through multiple channels, including changes in prescription behavior by replacement physicians, breaks in continuity of care, increased difficulty in securing a new provider, and longer waiting times for remaining practitioners. This paper provides the first comprehensive analysis of the effects of general practitioner (GP) departure on both directly affected patients and indirectly affected patients who experience spillovers due to increased demand on their physicians. We leverage an exhaustive French administrative health data to implement an event-study and difference-in-differences framework. We find that GP practice closures lead to a persistent decline in visits to general practitioners among affected patients, without a compensating increase in specialist consultations, hospital admissions, or diagnostic imaging. We detect no evidence of spillover effects on other patients of neighboring physicians. Finally, while heterogeneity by physician characteristics is limited, we document larger effects among younger patients with chronic conditions, suggesting a larger vulnerability to disruptions in primary care continuity.
"Maternity Leave and Family Ties ove the Life Cycle"
Abstract: The aim of this paper is to document the impact of maternity leave on family ties. Family ties is a key determinant of informal care over the life cycle. Thus, public policies affecting maternity leave might affect not only childcare arrangement but also elderly care arrangement later in life. We use eleven countries of the survey on health ageing, retirement in Europe (SHARE). We analyse the impact of maternity leave on distance to parent, emotional closeness and informal care provision. Because of reverse causality issues, we use changes in legal maternity leave duration in Europe between 1970 and 2000 as an instrumental variable. We find that maternity leave increases the probability of living further from their parents, but do not affect emotional closeness to parents, nor probability of providing care to their elderly disabled parents. This paper bridge a gap in the literature on the impact of maternity leave, and inform policy makers that while maternity leave does not seems to affect the probability of providing informal care, it might affect the burden of caregiver by increasing their distance to care-receiver.
Why Care about Who Pays for Care? An Analysis of Horizontal Inequity in Formal Care Use with Clémentine Garrouste and Florence Jusot
Abstract: The ageing population has led to an increasing number of individuals who need help with daily activities. These long-term care (LTC) needs can be provided by professional caregivers. However, accessing such services can be costly and a source of horizontal inequity, i.e. unequal access to care for individuals with similar needs. This paper examines income-related horizontal inequity (HI) in formal care use in France, and the role of three funding systems in HI: National Health Insurance, allowance and income tax deduction. Our findings reveal income-related inequities favouring wealthier individuals. We find evidence that half of the inequity stems from home care provided by professionals funded directly by income tax deduction, rather than through insurance or allowance-based schemes. In addition, while inequities disappear for formal care funded jointly by insurance and subsidies, they persist when funded exclusively by the National Health Insurance.
Severe Cognitive Impairments and Long-term Care In Germany with Axel Börsch-Supan, Johannes Geyer, Peter Haan, and Sami Louahlia
Abstract: Germany faces growing challenges in financing long-term care (LTC) for its aging population, particularly for individuals with severe cognitive impairment (SCI). Using data from the European SHARE survey (wave 9), this study estimates the economic burden of SCI on LTC.We find that 4%of elderly individuals living at home have SCI. They are 30% more likely to receive care. On average, they use six additional hours of both formal and informal care per week. However, our analysis shows that the primary driver of increased LTC use is not SCI itself, but the resulting limitations in activities of daily living (ADLs). Once ADLs are accounted for, SCI does not independently increase care needs. The annual cost of care for individuals with SCI is estimated at €10,000 per person, compared to €5,000 for those without SCI. For nursing home residents, who have a higher prevalence of SCI, annual LTC costs reach approximately €44,000 per capita. These findings highlight the significant economic impact of SCI on LTC financing in Germany.
"Is Economic Development an Unwavering Determinant of Suicide? Evidence from France, 1925-2017" with Florian Bonnet
Abstract: The recent increase in suicide rate in the Unites State among the middle-age white has shed light on research related to suicide. It revives the interest on questions related to the cause of suicide, both at the individual and at the society level. This paper address the question of the role of economic development in explaining suicide. We use a unique dataset of one century of information at the department level on death and economic development. This dataset has never been used before, and allows for the first time to have one century of History to raise the question of the association between suicide rate and economic development at the local level. Thus, it is the first paper to both show that social determinant of suicide evolve across time. France knew a turnaround: before the 60's, the economic development of a region was positively associated with suicide risk while from the 80's the most developed area were those with the lowest suicide rate.