Serange-Fonterme R
Soc Sci Med. 1985;21(2):103-13. doi: 10.1016/0277-9536(85)90078-4.
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 orientated, 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 polarizing 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.
我们的研究源于在国家科学研究中心组织的一项研究计划框架内，对里昂地区医疗支出进行的微观经济调查。这项研究基于从里昂统计与经济研究所抽取的3500户家庭（或10000个人）的样本。关于个人医疗支出的信息取自社会保障档案以及参与调查的不同医院机构。分析一方面主要针对社会经济因素，其在医疗需求中的作用直到最近才得以确立；另一方面针对供给因素，其对个人行为的影响仍未得到充分考虑。我们的研究结果证实，社会分化的主要标准存在于支出的“一种替代形式”中。私营部门的商品和服务类型存在显著差异：在对私立或公立医疗保健的偏好“选择”上；在住院需求的性质方面。然而，可能就供给而言，里昂调查的数据得出了最有趣的结论。在私立医院护理方面，可以看到供给可能以一种相对独立于社会阶层的方式对个人医疗支出产生自主影响。关于住院治疗，一项关于住院模式的研究揭示了在住院患者居住区域内的医院和诊所周围，住院需求存在两极分化效应。观察到的“自我住院”现象的运作方式相对独立于个人的社会背景，而且通常也独立于机构所提供床位的公立或私立性质。随后在一方面是公共部门与另一方面是营利性私营部门之间出现了替代效应。然而，地理位置与某些个人选择无关。总之，一方面社会分化的逻辑与另一方面供给体系的逻辑并非绝对不同。然而，要充分理解医疗保健供需之间形成的复杂关系，必然需要获取关于个体疾病的数据。
