Concurrence, prix et qualité de la prise en charge en EHPAD en France : Analyses micro-économétriques

High prices and insufficient quality of care are observed in nursing homes in France. Reforms are currently under discussion, but governments are facing a dilemma : any measure of price cut is likely to affect quality and any improvement in quality would probably be inflationary. This work analyzes if this dilemma can be solved by focusing more particularly on the potential effect of real and yardstick competition that could be introduced in this long term care sector. Using a micro-econometric framework, we organize this analysis into three research issues : (i) What might be expected from the pricing reform and the increase in the number of beds in nursing homes currently proposed ? (ii) How the development of for-profit nursing homes could reduce prices and improve quality ? (iii) Are there local difficulties responsible for the poor quality of nursing homes ? Several implications for public policy may be involved. Using cost frontier estimates, we demonstrate that the reform plans would reduce inefficiency and nursing home prices, but at the expense of their quality. The rise of for-profit nursing homes leads to high prices and a deterioration of the quality of care which could be tempered however by a more competitive market structure. Nursing homes face local difficulties in nursing staff retention, affecting their quality and which do not seem to be solved by adjusting wages.