Geographic variation in admissions for knee replacement, hip replacement, and hip fracture in France: evidence of supplier-induced demand in for-profit and not-for-profit hospitals

William B. Weeks (1) , Marie Jardin , Jean-Charles Dufour (2, 3, 4) , Alain Paraponaris (5) , Bruno Ventelou (5, 1)

1 GREQAM - Groupement de Recherche en Économie Quantitative d'Aix-Marseille
2 LERTIM - Laboratoire d'Enseignement et de Recherche sur le Traitement de l'Information Médicale
3 AMU - Aix Marseille Université
4 SESSTIM - U912 INSERM - Aix Marseille Univ - IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale
5 ORS PACA

INTRODUCTION: We sought to determine whether there was evidence of supplier-induced demand in mainland France, where health care is mainly financed by a public and compulsory health insurance and provided by both for-profit and not-for-profit hospitals. METHODS: Using a dataset of all admissions to French hospitals for 2009 and 2010, we calculated department-level age-adjusted and sex-adjusted per capita admission rates for hip replacement, knee replacement, and hip fracture for 2 age groups (45-64 and 65-99 y old), for-profit and not-for-profit hospitals. We used spatial regression analysis to examine the relationship between ecological variables, procedure rates, and supply of surgeons or sector-specific surgical beds. RESULTS: The large majority of hip and knee replacement surgeries were performed in for-profit hospitals, whereas the large majority of hip fracture admissions were in not-for-profit hospitals; nonetheless, we found approximately 2-fold variation in per capita rates of hip and knee replacement surgery in both age groups and settings. Spatial regression results showed that among younger patients, higher incomes were associated with lower admission rates; among older patients, higher levels of reliance on social benefits were associated with lower rates of elective surgery in for-profit hospitals. Although overall surgical bed supply was not associated with admission rates, for-profit-specific and not-for-profit-specific bed supply were associated with higher rates of elective procedures within a respective hospital type. DISCUSSION: We found evidence of supplier-induced demand within the French for-profit and not-for-profit hospital systems; however, these systems appear to complement one another so that there is no overall national supplier-induced effect.

Mots clés: Aged; Aged; 80 and over; Arthroplasty; Replacement; Hip; Hip/*statistics & numerical data; Knee; Knee/*statistics & numerical data; Bias (Epidemiology); Female; France; Health Services Needs and Demand; Health Services Needs and Demand/*statistics & numerical data; Hip Fractures; Hip Fractures/*therapy; Hospitals; Proprietary; Proprietary/*statistics & numerical data; Voluntary; Voluntary/*utilization; Humans; Knee Injuries; Knee Injuries/therapy; Male; Middle Aged; Patient Admission; Patient Admission/*statistics & numerical data

Domaines: Sciences de l'Homme et Société; Economies et finances

William B. Weeks, Marie Jardin, Jean-Charles Dufour, Alain Paraponaris, Bruno Ventelou. Geographic variation in admissions for knee replacement, hip replacement, and hip fracture in France: evidence of supplier-induced demand in for-profit and not-for-profit hospitals. Medical Care, 2014, 52 (10), pp.909--917. ⟨10.1097/MLR.0000000000000211⟩. ⟨hal-01463910⟩