Blandine Legendre (p), Aude Lapinte

Delphine Burguet

Healthcare access is one of the key challenges met by public policies, and a major issue in the current affairs in France especially. In this paper, we address healthcare access in its various facets (financial, geographical and social), through the study of unmet needs. By « unmet needs » one means identifying the need for care, but without actually going to the doctor. Reasons to this « renunciation to care » may be based on individual constraints (financial, temporal, social, and psychological), or related to limitations of the health care system (geographical accessibility and density). In order to be able to design appropriate public health policies, targeting populations with insufficient access to care, it is important to identify which limitations play the most on unmet needs, and how they lead to this situation.
To investigate this issue, we use the French Statistics on Income and Living Conditions (SILC). This survey is a very rich source of information, collecting data on income, social inclusion, housing conditions, labor, education and health. Using Logit models, we measure the impact of financial constraints (health coverage, income, and other indicators of insufficient resources), social inclusion (living conditions, work situation, and poor social relations), and healthcare system accessibility (through an indicator of adjustment between supply and demand for care at the city-level) on the decision of not going to the doctor.

Joakim Wernberg (p)

Delphine Burguet

In this paper, I develop a conceptual model to identify and analyze trade-offs and critical factors in the digitalization of healthcare services in Sweden. Focusing on common denominators across sectors in digitalization with respect to social and economic activities, I synthesize findings from the study of (1) multi-sided platforms, (2) automation and the re-organization of work and (3) data-driven development to the Swedish healthcare sector. In addition, I use the conceptual model to compare and differentiate between the traditional healthcare providers and the emerging digital healthcare services provided by entrepreneurs from the outside of the established institutional framework. The Swedish case provides a combination of a developed Nordic welfare state with a high take-up of new digital technologies. This should make for a strong case for the digitalization of healthcare and strong potential for digital entrepreneurship and future export in digital healthcare services.

Anna-Theresa Renner (p), Dieter Pennerstorfer

Delphine Burguet

In health economic and policy research the spatial dimension of demand and supply is often ignored or insufficiently regarded. This paper aims to add to the methodological development in this field by linking research methods from health economics with regional science and geography. We investigate the availability and spatial accessibility of public outpatient healthcare services and want to gain insight into how we would expect patients to reallocate if the regional level of service provision changes. Methodologically, we argue that the usually employed model for explaining spatial interactions, the gravity model, is not suitable for explaining variations in patient flows and propose a measure that incorporates spatial accessibility and availability of physician services: Two-Step Floating Catchment Areas (2SFCA). The advantage of the proposed methodology is that (1) it takes into account the precise location of physicians and the distribution of potential patients within a district, which is especially relevant for regions with an uneven population and/or physician distribution, where the regional physician density can be a misleading measure of accessibility, (2) it can predict the redistribution of patients in case of a change in supply without posing any assumptions about causality, under/overutilization or changes in the magnitude of utilization, (3) it does not require patient level data and (4) it can be applied to other fields of regional economics where spatial flows of agents are a relevant parameter (e.g. work migration versus commuting, consumer flows and commercial centre development). We show that 2SFCA considerably increase the explanatory power of a gravity model for patient flows. The results are robust to changes of the specification of the distance decay function.