AMU - AMSE
5-9 Boulevard Maurice Bourdet, CS 50498
13205 Marseille Cedex 1
- People
- Ventelou
Ventelou
Status
Research professor
Research fields
Health economics
Macroeconomics
Thesis
1995
,
Paris School of Economics, EHESS
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Contact
bruno.ventelou[at]univ-amu.fr
+33(0)4 13 55 25 82
Address
Îlot Bernard du Bois
Publications
We study the behavioral determinants of COVID-19 vaccination uptake. The vaccine-pass policy, implemented in several countries in 2021, conditioned the access to leisure and consumption places to being vaccinated against COVID-19 and created an unprecedented situation where individuals’ access to consumption goods and vaccine status were interrelated. We rely on a quasi-hyperbolic discounting model to study the plausible relationships between time preference and the decision to vaccinate in such context. We test the predictions of our model using data collected from a representative sample of the French population (N = 1034) in August and September 2021. Respondents were asked about their COVID-19 vaccination status (zero, one, or two doses), as well as their economic and social preferences. Preference elicitations were undertaken online through incentivized tasks, with parallel collection of self-stated preferences. Factors associated with COVID-19 vaccination were investigated using a logistic model. Both elicited and stated impatience were found to be positively associated with COVID-19 vaccination decisions. These results suggest that impatience is a key motivational lever for vaccine uptake in a context where the vaccination decision is multidimensional and impacts the consumption potential. Results also serve to highlight the potential effectiveness of public communications campaigns based on time preferences to increase vaccination coverage.
BACKGROUND: Sexual and gender diverse people face intersecting factors affecting their well-being and livelihood. These include homophobic reactions, stigma or discrimination at the workplace and in healthcare facilities, economic vulnerability, lack of social support, and HIV. This study aimed to examine the association between such factors and symptoms of anxiety and depression among sexual and gender diverse people.
METHODS: This study is based on a sample of 108,389 gay, bisexual, queer and questioning men, and transfeminine people from 161 countries collected through a cross-sectional internet survey. We developed a multinomial logistic regression for each group to study the associations of the above factors at different severity scores for anxiety and depression symptoms.
RESULTS: Almost a third (30.3%) of the participants reported experiencing moderate to severe symptoms of anxiety and depression. Higher severity scores were found for transfeminine people (39%), and queer or questioning people (34.8%). Severe symptoms of anxiety and depression were strongly correlated with economic hardship for all groups. Compared to those who are HIV-negative, those living with HIV were more likely to report severe symptoms of anxiety and depression, and the highest score was among those who do not know their HIV status. Transfeminine people were the most exposed group, with more than 80% higher risk for those living with HIV suffering from anxiety and depression. Finally, homophobic reactions were strongly associated with anxiety and depression. The relative risk of severe anxiety and depression was 3.47 times higher for transfeminine people facing transphobic reactions than those with no symptoms. Moreover, anxiety and depression correlate with stigma or discrimination in the workplace and healthcare facilities.
CONCLUSIONS: The strong association between the severity of anxiety and depression, and socioeconomic inequality and HIV status highlights the need for concrete actions to meet the United Nations' pledge to end inequalities faced by communities and people affected by HIV. Moreover, the association between stigma or discrimination and anxiety and depression among sexual and gender diverse people is alarming. There is a need for bold structural public health interventions, particularly for transfeminine, queer and questioning people who represent three communities under the radar of national HIV programmes.
This article studies the behavioral and socio-demographic determinants of reported compliance with prophylactic measures against COVID-19: barrier gestures, lockdown restrictions and mask wearing. The study contrasts two types of measures for behavioral determinants: experimentally elicited preferences (risk tolerance, time preferences, social value orientation and cooperativeness) and stated preferences (risk tolerance, time preferences, and the GSS trust question). Data were collected from a representative sample of the inland French adult population (N=1154) surveyed during the first lockdown in May 2020, and the experimental tasks were carried out on-line. The in-sample and out-of-sample predictive power of several regression models - which vary in the set of variables that they include - are studied and compared. Overall, we find that stated preferences are better predictors of compliance with these prophylactic measures than preferences elicited through incentivized experiments: self-reported level of risk, patience and trust are predicting compliance, while elicited measures of risk-aversion, patience, cooperation and prosociality did not.
With the low adherence to voluntary mutual health insurance, Senegal’s policymakers have sought to understand the feasibility of compulsory health insurance membership. This study aims to measure the acceptability of mandatory membership in community-based mutual health insurance (CBHI) and to understand its possible administrative modalities. The study consists of a national survey among a representative population sample selected by marginal quotas. The survey was conducted in 2022 over the phone, with a random composition method involving 914 people. The questionnaire measured the socio-economic characteristics of households, their level of acceptability concerning voluntary and compulsory membership, and their level of confidence in CBHIs and the health system. Respondents preferred voluntary (86%) over mandatory (70%) membership of a CBHI. The gap between voluntary and compulsory membership scores was smaller among women (p = 0.040), people under 35 (p = 0.033), and people with no health coverage (p = 0.011). Voluntary or compulsory membership was correlated (p = 0.000) to trust in current CBHIs and health systems. Lack of trust in the CBHI management has been more disadvantageous for acceptance of the mandatory than the voluntary membership. No particular preference emerged as the preferred administrative channel (e.g. death certificate, identity card, etc.) to enforce the mandatory option. The results confirmed the well-known challenges of building universal health coverage based on CBHIs—a poorly appreciated model whose low performance reduces the acceptability of populations to adhere to it, whether voluntary or mandatory. Suppose Senegal persists in its health insurance approach. In that case, it will be essential to strengthen the performance and funding of CBHIs, and to gain population trust to enable a mandatory or more systemic membership.
Efficiency analyses have been widely used in the literature to rank countries regarding their health system performances. However, little place has been given to the environmental aspect: two countries with the same characteristics could experience completely different healthcare system outcomes just because they do not face the same environmental quality situation, which is a major determinant of the health of inhabitants.
Background:
Given the importance of the continuous follow-up of chronic patients, we evaluated the performance of French private practice general practitioners (GPs) practicing in multi-professional group practices (MGP) regarding chronic care management during the first Covid-19 lockdown in Spring 2020 compared to GPs not in MGP. We consider two outcomes: continuity of care provision for chronic patients and proactivity in contacting these patients.
Methods:
The cross-sectional web questionnaire of 1191 GPs took place in April 2020. We exploit self-reported data on: 1) the frequency of consultations for chronic patients during lockdown compared to their "typical" week before the pandemic, along with 2) GPs' proactive behaviour when contacting their chronic patients. We use probit and bivariate probit models (adjusted for endogeneity of choice of engagement in MGP) to test whether GPs in MGP had significantly different responses to the Covid-19 crisis compared to those practicing outside MGP.
Results:
Out of 1191 participants (response rate: 43.1%), around 40% of GPs were female and 34% were younger than 50 years old. Regression results indicate that GPs in MGP were less likely to experience a drop in consultations related to complications of chronic diseases (- 45.3%). They were also more proactive (+ 13.4%) in contacting their chronic patients compared to their peers practicing outside MGP.
Conclusion:
We demonstrate that the MGP organisational formula was beneficial to the follow-up of patients with chronic conditions during the lockdown; therefore, it appears beneficial to expand integrated practices, since they perform better when facing a major shock. Further research is needed to confirm the efficiency of these integrated practices outside the particular pandemic setup.
Background:
Epistemic injustices are increasingly decried in global health. This study aims to investigate whether the source of knowledge influences the perception of that knowledge and the willingness to use it in francophone African health policy-making context.
Methods:
The study followed a randomized experimental design in which participants were randomly assigned to one of seven policy briefs that were designed with the same scientific content but with different organizations presented as authors. Each organization was representative of financial, scientific or moral authority. For each type of authority, two organizations were proposed: one North American or European, and the other African.
Results:
The initial models showed that there was no significant association between the type of authority or the location of the authoring organization and the two outcomes (perceived quality and reported instrumental use). Stratified analyses highlighted that policy briefs signed by the African donor organization (financial authority) were perceived to be of higher quality than policy briefs signed by the North American/European donor organization. For both perceived quality and reported instrumental use, these analyses found that policy briefs signed by the African university (scientific authority) were associated with lower scores than policy briefs signed by the North American/European university.
Conclusions:
The results confirm the significant influence of sources on perceived global health knowledge and the intersectionality of sources of influence. This analysis allows us to learn more about organizations in global health leadership, and to reflect on the implications for knowledge translation practices.
The public acceptability of a policy is an important issue in democracies, in particular for anti-COVID-19 policies, which require the adherence of the population to be applicable and efficient. Discrete choice experiment (DCE) can help elicit preference ranking among various policies for the whole population and subgroups. Using a representative sample of the French population, we apply DCE methods to assess the acceptability of various anti-COVID-19 measures, separately and as a package. Owing to the methods, we determine the extent to which acceptability depends on personal characteristics: political orientation, health vulnerability, or age. The young population differs in terms of policy preferences and their claim for monetary compensation, suggesting a tailored policy for them. The paper provides key methodological tools based on microeconomic evaluation of individuals’ preferences for improving the design of public health policies.
This study aims to evaluate people’s willingness to provide their geospatial global positioning system (GPS) data from their smartphones during the COVID-19 pandemic. Based on the self-determination theory, the addition of monetary incentives to encourage data provision may have an adverse effect on spontaneous donation. Therefore, we tested if a crowding-out effect exists between financial and altruistic motivations. Participants were randomized to different frames of motivational messages regarding the provision of their GPS data based on (1) self-interest, (2) pro-social benefit, and (3) monetary compensation. We also sought to examine the use of a negative versus positive valence in the framing of the different armed messages. 1055 participants were recruited from 41 countries with a mean age of 34 years on Amazon Mechanical Turk (MTurk), an online crowdsourcing platform. Participants living in India or in Brazil were more willing to provide their GPS data compared to those living in the United States. No significant differences were seen between positive and negative valence framing messages. Monetary incentives of $5 significantly increased participants’ willingness to provide GPS data. Half of the participants in the self-interest and pro-social arms agreed to provide their GPS data and almost two-thirds of participants were willing to provide their data in exchange for $5. If participants refused the first framing proposal, they were followed up with a “Vickrey auction” (a sealed-bid second-priced auction, SPSBA). An average of $17 bid was accepted in the self-interest condition to provide their GPS data, and the average “bid” of $21 was for the pro-social benefit experimental condition. These results revealed that a crowding-out effect between intrinsic and extrinsic motivations did not take place in our sample of internet users. Framing and incentivization can be used in combination to influence the acquisition of private GPS smartphone data. Financial incentives can increase data provision to a greater degree with no losses on these intrinsic motivations, to fight the COVID-19 pandemic.
Efficiency within the health system is well recognised as key for achieving Universal Health Coverage (UHC). However, achieving equity and efficiency simultaneously is often seen as a conflicting effort. Using 12 years of data (2003–2014) from the selection of a number of low- and lower middle-income countries (Afghanistan, Bangladesh, Burkina Faso, Ghana, Indonesia, Mongolia, Mozambique, Tajikistan, Togo, Uzbekistan and Yemen Republic), we compute an index of Universal health coverage (UHC), measure the health system’s performance (HSp) and, finally, investigate the cross-dynamics of the resulting HSp and the UHC previously obtained. We find that, with the few exceptions over the statistical sample, the causality between performances of the national health system and the universal health coverage is typically bidirectional. From an empirical standpoint, our findings challenge the idea from economic orthodoxy that efficiency must precede equity in healthcare services. Rather, our findings support the view of simultaneous efforts to improve expansion of the coverage and efficiency of the health system, directing attention towards the importance of organisation of the health system in the country context.
This study examines the acceptance of artificial intelligence (AI)-based diagnostic alternatives compared to traditional biological testing through a randomized scenario experiment in the domain of neurodegenerative diseases (NDs). A total of 3225 pairwise choices of ND risk-prediction tools were offered to participants, with 1482 choices comparing AI with the biological saliva test and 1743 comparing AI+ with the saliva test (with AI+ using digital consumer data, in addition to electronic medical data). Overall, only 36.68% of responses showed preferences for AI/AI+ alternatives. Stratified by AI sensitivity levels, acceptance rates for AI/AI+ were 35.04% at 60% sensitivity and 31.63% at 70% sensitivity, and increased markedly to 48.68% at 95% sensitivity (p <0.01). Similarly, acceptance rates by specificity were 29.68%, 28.18%, and 44.24% at 60%, 70%, and 95% specificity, respectively (P < 0.01). Notably, AI consistently garnered higher acceptance rates (45.82%) than AI+ (28.92%) at comparable sensitivity and specificity levels, except at 60% sensitivity, where no significant difference was observed. These results highlight the nuanced preferences for AI diagnostics, with higher sensitivity and specificity significantly driving acceptance of AI diagnostics.
Background Within the International Health Regulations framework, the French High Council for Public Health was mandated in 2022 by health authorities to establish a list of priority infectious diseases for public health, surveillance and research in mainland and overseas France. Aim Our objective was to establish this list. Methods A multi-criteria decision analysis was used, as recommended by the European Centre for Disease Prevention and Control. A list of 95 entities (infectious diseases or groups of these, including the World Health Organization (WHO)-labelled ‘Disease X’) was established by 17 infectious disease experts. Ten criteria were defined to score entities: incidence rate, case fatality rate, potential for emergence and spread, impact on the individual, on society, on socially vulnerable groups, on the healthcare system, and need for new preventive tools, new curative therapies, and surveillance. Each criterion was assigned a relative weight by 77 multidisciplinary experts. For each entity, 98 physicians from various specialties rated each criterion against the entity, using a four-class Likert-type scale; the ratings were converted into numeric values with a nonlinear scale and respectively weighted to calculate the entity score. Results Fifteen entities were ranked as high-priorities, including Disease X and 14 known pathologies (e.g. haemorrhagic fevers, various respiratory viral infections, arboviral infections, multidrug-resistant bacterial infections, invasive meningococcal and pneumococcal diseases, prion diseases, rabies, and tuberculosis). Conclusion The priority entities agreed with those of the WHO in 2023; almost all were currently covered by the French surveillance and alert system. Repeating this analysis periodically would keep the list updated.
