Les disparites sociales de consommation medicale

Abstract

Our study stems from a micro-economic survey of medical expenditure in the Lyons region carried out within the framework of a research programme organised by the National Centre for Scientific Research. This study is based on a sampling of 3500 households (or 10,000 individuals) taken from the Lyons Institute of Statistics and Economic Studies. Information on individual medical expenditure was taken from Social Security files and from the different hospital establishments involved in the enquiry. The analysis was mainly oriented, on the one hand, towards socio-economic factors whose role in the demand for medical care has only recently been established, and, on the other hand, towards factors of supply whose incidence on individual behaviour still remains insufficiently considered. Our results confirmed that the major criterion of social differentiation was to be found in ‘an alternative form’ of expenditure. There are significant variations in the type of goods and services in the private sector: in the preferred ‘choice’ made in favour of either private or public health care; in the nature of the demand for hospitalisation. It is probably, however, in regard to supply, that the data of the Lyonnais enquiry have provided the most interesting conclusions. In private hospital care it was seen that supply could have an autonomous effect on individual medical expenditure in a manner relatively independent of social stratum. As regards hospitalisation, a study on patterns in hospital admission brought to light a polarising effect on the demand for hospital admission around hospitals and clinics located in the residence area of the inpatients. The phenomenon of ‘self-admission’ observed operates in a manner relatively independent of the social background of the individual and also very often independently of the public or private nature of the beds at the establishment's disposal. There followed a substitution effect between the public sector on the one hand and the profit-making private sector on the other. Geographical location, however, has no bearing on certain individual choices. In conclusion, it appeared that the logic of social differentiation on the one hand, and the logic of the system of supply on the other, were not absolutely distinct. However, the need for a sound understanding of the complex relations which form between the supply and demand of medical care should necessarily require access to data in individual illness.