Planification de l’offre de soins et télémédecine

Abstract

The existence of geographical disparities in the French supply of medical care begs the question of the adjustment between needs and effective access to medical care. This access depends on the sharing out of financial resources, first between regions and second between medical infrastructures in each region. The two priorities of the government in the field of Health, which are equality in medical care access and the control of medical public spending, may obviously be conflicting. The concentration of medical activities in some regions and the agglomeration of specialized hospitals in urban centers can be observed. So the methods used by the government to plan medical supply seem to be inefficient in resolving this geographical imbalance. The use of Information and Communication Technologies (ICT) in the field of Health appears to be an innovative solution. In particular, the development of telemedicine may resolve the problem of medical supply concentration. The first contribution of the paper is to develop a theoretical model in order to explain the French disparities in hospital medical care access between urban and rural areas in the same region. It describes the allocation of public funds to hospitals in a region, which determines the medical care supply in this region. We show that the optimal allocation mechanism leads to large disparities between the two areas in terms of quality of medical care access and of utility. Second, we introduce telemedicine into our model to measure its effect on the inequality in medical care access. We show that telemedicine increases regional utility only if the urban area has a great advantage in terms of medical infrastructures. This result implies that telemedicine has to be considered as an alternative to public policies attempting to re-allocate the funds between the two areas. We then propose some public policy recommendations concerning the development of telemedicine.