Regulation of the drug market : 3 essays in applied microeconomics ; Réguler le marché de ville du médicament français : Trois essais de microéconomie appliquée

Abstract

This thesis addresses several issues: on the one hand, we focus on policies for controlling drug expenditures: on the other hand, we analyze the price competition on the OTC drugs market, in a context of drugs delisting policies.In recent years, some plans to affect change and improve prescribing practices are developed, with the emergence of physician profiling methods. The first chapter wonders about such a profiling in the current information system. Results show that outliers can be correctly identified; but to broaden profiling, we have to use some disease-specific indicators, or to improve information systems with diagnostic codes to define more general indicators.In addition to patient health, various sociological and economic factors may influence physician practices, including the competitive environment. The second chapter focuses on the unequal spatial distribution of general practitioners on drugs prescribing variability. Results are sensitive to the specification used for the medical density variable and suggest there is no effect of the density variation on the average prescribing cost per patient and per physician. However, this result reflects the sum of two opposite effects that cancel.In a context where the sale of OTC drugs outside pharmacies is controversial, the third chapter show there is no price competition between pharmacies on this market segment. ; Cette thèse s'intéresse, d'une part à la question de la maîtrise des dépenses de médicaments, et d'autre part à l'analyse de la concurrence en prix sur le marché des médicaments non remboursables, à la lumière des politiques de déremboursement.Ces dernières années, des actions visant à modifier les pratiques des prescripteurs se développent avec des actions de ciblage des médecins. Le premier chapitre de cette thèse pose ainsi la question de l'identification de ces médecins dans les systèmes d'informations actuels. Les résultats montrent que si les médecins généralistes outliers peuvent être identifiés correctement, il est néanmoins ...