ISSN:1058-6407    

DOI:10.1111/j.1430-9134.1994.00001.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Under prospective pricing, payers for health care essentially use price regulation of hospitals as a way of indirectly regulating the provision of treatment intensity. This paper presents a theory of how a nonprofit hospital selects treatment intensities for its products given the payer's choice of prices and then determines how the payer should select prices in light of this theory. The main result is that, in equilibrium, the ratio of price to marginal cost will vary across products inversely with the elasticity of demand with respect to treatment intensity. This means that, generally, the hospital will earn positive (negative) accounting profit on products with low‐(high‐) intensity elasticities of dem

ISSN:1058-6407    

DOI:10.1111/j.1430-9134.1994.00007.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

In the present study I identify an inherent characteristic of health care markets that may lead to excessive investment by hospitals even when compensated according to a prospective reimbursement rule. It is demonstrated that the stochastic nature of the demand for medical services combined with the lumpiness of investment decisions may give rise to excessive investment when multiple hospitals select independently their levels of capacities. The source for the excessive incentives to invest is the difficulty of one hospital to internalize properly the externality generated by its investment decisions. Such an externality arises because when one hospital expands its capacity, it is more likely to be able to serve not only patients residing in its region but patients residing in neighboring regions as well.

ISSN:1058-6407    

DOI:10.1111/j.1430-9134.1994.00053.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

This paper studies a model in which two payers contract with one hospital. True costs per patient are not a possible basis for payment, and contracts can only be written on the basis of allocated cost. Payers choose a contract that is fully prospective or fully based on cost allocation, or a payment scheme that would give some weight to each of these two. We characterize the payers'equilibrium contracts arid show how in equilibrium hospital input decisions are distorted by the payers’ incentives to engage in cost shifting. Two cost‐shifting incentives work in opposite directions, and equilibrium can be characterized by too little or too much care relative to the socially efficient le

ISSN:1058-6407    

DOI:10.1111/j.1430-9134.1994.00071.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

This paper compares the cost and quality incentive effects of cost reimbursement and prospective payment systems in the health industry. When a provider cannot refuse patients who require high treatment costs or discriminate patients by qualities, optimally designed prospective payments can implement the efficient quality and cost reduction efforts, but cost reimbursement cannot induce any cost incentive. When the provider can refuse expensive patients, implementation of the first best requires a piecewise linear reimbursement rule that can be interpreted as a mixture of pure prospective payment and pure cost reimbursement, Under appropriate conditions, prospective payment can implement the first best even when the provider can use qualities to discriminate patients.

ISSN:1058-6407    

DOI:10.1111/j.1430-9134.1994.00093.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Legislation to create optional no‐fault insurance (ONFL) programs has recently been enacted in Florida and Virginia. ONFI programs provide compensation to patients when certain medical complications arise, provided the patient agrees not to sue the doctor for additional damages. The optimal design of ONFI programs is explored in this paper, focusing on the incentive effects of ONFI programs. The question of whether ONFI programs should be funded entirely by participating doctors, or whether social subsidies are optimal, is examine

ISSN:1058-6407    

DOI:10.1111/j.1430-9134.1994.00113.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

This paper uses origin‐destination data to define geographic local hospital markets in large metropolitan statistical areas (MSAs). Results support past findings of service rather than price competition, with negative‐cost Herfandahl‐Hirschman indexes relationships at the market level (and sub‐MSA level) and with profit margins negatively related to hospital market competition. The effects of total (direct plus indirect) market competition are unchanged between 1983 and 1988, precisely estimated, robust to estimation techniques, and unaffected by whether the number of direct competitors is included as an explanatory v

ISSN:1058-6407    

DOI:10.1111/j.1430-9134.1994.00143.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:1058-6407    

DOI:10.1111/j.1430-9134.1994.00169.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

What is the nature of the industrial organization of the market for physician services? Is the market “competitive?” Are there pareto‐relevant market failures, such that there is room for welfare‐improving policies? Economists have devoted a great deal of attention to this market, but it remains relatively poorly understood. The key features of this market are that the product being sold is a professional service, and the pervasive presence of insurance for consumers. A professional service is inherently heterogeneous, nonretradable, and subject to an asymmetry of information between buyers and sellers. These characteristics are what bestow market power on sellers, further strengthened by the fact that consumers face only a small fraction of the price of any service due to insurance. This paper considers the implications of these characteristics for agency relationships between patients and physicians, and insurers (both private and public) and physicians. Agency relationships within physician firms are also considered. Both theoretical and empirical modeling of contracting between insurers and physicians and of the joint agency problems between patient and physician and insurer and physician are recommended as areas for future research. Because failures in this market are seen to derive largely from the structure of information, the potential gains from government intervention may be sharply circumscribed. Nonetheless, careful consideration of the competitive implications of contracting between physicians, insurers, and other health care providers is an important area for antitrust

ISSN:1058-6407    

DOI:10.1111/j.1430-9134.1994.00211.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY