title: Geographic variation in admissions for knee replacement, hip replacement, and hip fracture in France: evidence of supplier-induced demand in for-profit and not-for-profit hospitals.
abstract: BACKGROUND
  We sought to determine whether there was evidence of supplier-induced demand in mainland France, where health care is mainly financed by a public and compulsory health insurance and provided by both for-profit and not-for-profit hospitals.
  
  
  METHODS
  Using a dataset of all admissions to French hospitals for 2009 and 2010, we calculated department-level age-adjusted and sex-adjusted per capita admission rates for hip replacement, knee replacement, and hip fracture for 2 age groups (45-64 and 65-99 y old), for-profit and not-for-profit hospitals. We used spatial regression analysis to examine the relationship between ecological variables, procedure rates, and supply of surgeons or sector-specific surgical beds.
  
  
  RESULTS
  The large majority of hip and knee replacement surgeries were performed in for-profit hospitals, whereas the large majority of hip fracture admissions were in not-for-profit hospitals; nonetheless, we found approximately 2-fold variation in per capita rates of hip and knee replacement surgery in both age groups and settings. Spatial regression results showed that among younger patients, higher incomes were associated with lower admission rates; among older patients, higher levels of reliance on social benefits were associated with lower rates of elective surgery in for-profit hospitals. Although overall surgical bed supply was not associated with admission rates, for-profit-specific and not-for-profit-specific bed supply were associated with higher rates of elective procedures within a respective hospital type.
  
  
  CONCLUSIONS
  We found evidence of supplier-induced demand within the French for-profit and not-for-profit hospital systems; however, these systems appear to complement one another so that there is no overall national supplier-induced effect.
authors.affiliation: *The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH †The Aix-Marseille School of Economics ‡SESSTIM, UMR 912 INSERM-IRD-Aix-Marseille Université §Observatoire Régional de la Santé PACA ∥CNRS-GREQAM, Marseille, France.
authors.forename: William B
authors.initials: WB
authors.lastname: Weeks
authors.forename: Marie
authors.initials: M
authors.lastname: Jardin
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Dufour
authors.forename: Alain
authors.initials: A
authors.lastname: Paraponaris
authors.forename: Bruno
authors.initials: B
authors.lastname: Ventelou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D015982:Bias; D005260:Female; D005602:France; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006620:Hip Fractures / Q000628:therapy*; D006777:Hospitals, Proprietary / Q000706:statistics & numerical data*; D006788:Hospitals, Voluntary / Q000706:statistics & numerical data*; D006801:Humans; D007718:Knee Injuries / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*