Publish or Perish – do French hospitals disclose their greenhouse gas emissions for vertical differentiation?

Nathalie Clavel, Laurie Marrauld (), Myriam Lescher-Cluzel, Estelle Baurès () and Nicolas Sirven ()
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Nathalie Clavel: School of Public Health [Montréal, Canada] - UdeM - Université de Montréal
Laurie Marrauld: UR - Université de Rennes, ARENES - Arènes: politique, santé publique, environnement, médias - UR - Université de Rennes - Institut d'Études Politiques [IEP] - Rennes - EHESP - École des Hautes Études en Santé Publique [EHESP] - UR2 - Université de Rennes 2 - CNRS - Centre National de la Recherche Scientifique, EHESP - École des Hautes Études en Santé Publique [EHESP], IDM - Institut du Management - EHESP - École des Hautes Études en Santé Publique [EHESP], RSMS - Recherche sur les services et le management en santé - UR - Université de Rennes - EHESP - École des Hautes Études en Santé Publique [EHESP] - INSERM - Institut National de la Santé et de la Recherche Médicale - CNRS - Centre National de la Recherche Scientifique
Myriam Lescher-Cluzel: EHESP - École des Hautes Études en Santé Publique [EHESP], SHS - Département des sciences humaines et sociales - EHESP - École des Hautes Études en Santé Publique [EHESP]
Estelle Baurès: Agrocampus Ouest (Rennes)
Nicolas Sirven: UR - Université de Rennes, ARENES - Arènes: politique, santé publique, environnement, médias - UR - Université de Rennes - Institut d'Études Politiques [IEP] - Rennes - EHESP - École des Hautes Études en Santé Publique [EHESP] - UR2 - Université de Rennes 2 - CNRS - Centre National de la Recherche Scientifique, RSMS - Recherche sur les services et le management en santé - UR - Université de Rennes - EHESP - École des Hautes Études en Santé Publique [EHESP] - INSERM - Institut National de la Santé et de la Recherche Médicale - CNRS - Centre National de la Recherche Scientifique, EHESP - École des Hautes Études en Santé Publique [EHESP], IDM - Institut du Management - EHESP - École des Hautes Études en Santé Publique [EHESP], IRDES - Institut de Recherche et Documentation en Economie de la Santé - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres

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Abstract: French legislation requires large and medium-sized hospitals to publicly report their greenhouse gas (GHG) emissions. Yet, many hospitals fail to comply with this regulation, while others report voluntarily. The organizational drivers behind this behavior remain underexplored. This study examines whether hospitals disclose their GHG emissions as part of a broader strategy to differentiate themselves—similar to how they report patient satisfaction scores to signal quality. We explore whether carbon reporting is used as a vertical differentiation strategy in the French healthcare system. We used a mixed-methods approach. First, we analyzed national administrative data to test whether reporting GHG emissions is associated with reporting patient satisfaction scores. Second, we conducted semi-structured interviews with hospital managers to understand the motivations behind emissions reporting. Quantitatively, we found no significant association between the two types of reporting. Hospitals do not appear to use GHG emissions disclosure and patient satisfaction scores as part of the same signaling strategy. Qualitative findings confirmed that GHG reporting is primarily driven by internal factors such as executive leadership, process improvement, and organizational values, rather than external differentiation or patient demand. Carbon reporting in French hospitals is not currently used as a differentiation strategy. Stronger regulatory enforcement is needed to ensure compliance. In addition, hospitals require support—through methodological guidance, training, and the development of dedicated sustainability roles—to integrate environmental performance into their management systems and contribute meaningfully to healthcare decarbonization.

Keywords: Mixed-methods study; Sustainability in healthcare; Patient satisfaction; Healthcare quality indicators; Public reporting; Hospital performance; Carbon footprint reporting; Greenhouse gas emissions (search for similar items in EconPapers)
Date: 2025-08-31
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Published in International Journal of Health Economics and Management, In press, ⟨10.1007/s10754-025-09402-w⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-05252013

DOI: 10.1007/s10754-025-09402-w

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