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Optimal Contracting with Altruistic Agents: Medicare Payments for Dialysis Drugs

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  • Martin Gaynor
  • Nirav Mehta
  • Seth Richards-Shubik

Abstract

We study health-care provider agency and optimal payments, considering an expensive medication for dialysis patients. Using Medicare claims data we estimate a structural model of treatment decisions, in which providers differ in their altruism and marginal costs, and this heterogeneity is unobservable to the government. In a novel application of nonlinear pricing methods, we empirically characterize the optimal contracts in this environment. The optimal contracts eliminate medically excessive dosages and reduce expenditures, resulting in approximately $300 million in annual gains from better contracting. This approach could be applied to a broad class of problems in healthcare payment policy.

Suggested Citation

  • Martin Gaynor & Nirav Mehta & Seth Richards-Shubik, 2023. "Optimal Contracting with Altruistic Agents: Medicare Payments for Dialysis Drugs," American Economic Review, American Economic Association, vol. 113(6), pages 1530-1571, June.
    • Handle: RePEc:aea:aecrev:v:113:y:2023:i:6:p:1530-71
    DOI: 10.1257/aer.20210208
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    More about this item

    JEL classification:

    • D64 - Microeconomics - - Welfare Economics - - - Altruism; Philanthropy; Intergenerational Transfers
    • D86 - Microeconomics - - Information, Knowledge, and Uncertainty - - - Economics of Contract Law
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • J33 - Labor and Demographic Economics - - Wages, Compensation, and Labor Costs - - - Compensation Packages; Payment Methods
    • L21 - Industrial Organization - - Firm Objectives, Organization, and Behavior - - - Business Objectives of the Firm

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