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Static and dynamic efficiency of irreversible health care investments under alternative payment rules

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  • Levaggi, R.
  • Moretto, M.
  • Pertile, P.

Abstract

The paper studies the incentive for providers to invest in new health care technologies under alternative payment systems, when the patients’ benefits are uncertain. If the reimbursement by the purchaser includes both a variable (per patient) and a lump-sum component, efficiency can be ensured both in the timing of adoption (dynamic) and the intensity of use of the technology (static). If the second instrument is unavailable, a trade-off may emerge between static and dynamic efficiency. In this context, we also discuss how the regulator could use control of the level of uncertainty faced by the provider as an instrument to mitigate the trade-off between static and dynamic efficiency. Finally, we calibrate the model to study a specific technology and estimate the cost of a regulatory failure.

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Bibliographic Info

Article provided by Elsevier in its journal Journal of Health Economics.

Volume (Year): 31 (2012)
Issue (Month): 1 ()
Pages: 169-179

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Handle: RePEc:eee:jhecon:v:31:y:2012:i:1:p:169-179

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Web page: http://www.elsevier.com/locate/inca/505560

Related research

Keywords: Health care technologies; Dynamic efficiency; Static efficiency; Real options;

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References

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  1. Chalkley, Martin & Malcomson, James M, 1998. "Contracting for Health Services with Unmonitored Quality," Economic Journal, Royal Economic Society, vol. 108(449), pages 1093-1110, July.
  2. Chalkley, M. & Malcomson, J.M., 1998. "Government purchasing of health services," Discussion Paper Series In Economics And Econometrics 9821, Economics Division, School of Social Sciences, University of Southampton.
  3. Rosella Levaggi & Michele Moretto & Paolo Pertile, 2010. "Static and Dynamic Efficiency of Irreversible Health Care Investments under Alternative Payment Rules," Working Papers 2010.130, Fondazione Eni Enrico Mattei.
  4. Dixit, Avinash & Pindyck, Robert S & Sodal, Sigbjorn, 1999. "A Markup Interpretation of Optimal Investment Rules," Economic Journal, Royal Economic Society, vol. 109(455), pages 179-89, April.
  5. Paolo Pertile, 2008. "Investment in Health Technologies in a Competitive Model with Real Options," Journal of Public Economic Theory, Association for Public Economic Theory, vol. 10(5), pages 923-952, October.
  6. Amitabh Chandra & Jonathan S. Skinner, 2011. "Technology Growth and Expenditure Growth in Health Care," NBER Working Papers 16953, National Bureau of Economic Research, Inc.
  7. Bokhari, Farasat A.S., 2009. "Managed care competition and the adoption of hospital technology: The case of cardiac catheterization," International Journal of Industrial Organization, Elsevier, vol. 27(2), pages 223-237, March.
  8. Joseph P. Newhouse, 1992. "Medical Care Costs: How Much Welfare Loss?," Journal of Economic Perspectives, American Economic Association, vol. 6(3), pages 3-21, Summer.
  9. McClellan, Mark, 1995. "Uncertainty, Health-Care Technologies, and Health-Care Choices," American Economic Review, American Economic Association, vol. 85(2), pages 38-44, May.
  10. Rossella Levaggi & Michele Moretto & Vincenzo Rebba, 2007. "Investment decisions in hospital technology when physicians are devoted workers," "Marco Fanno" Working Papers 0048, Dipartimento di Scienze Economiche "Marco Fanno".
  11. Paolo Pertile & Emanuele Torri & Luciano Flor & Stefano Tardivo, 2009. "The timing of adoption of positron emission tomography: a real options approach," Health Care Management Science, Springer, vol. 12(3), pages 217-227, September.
  12. Susan C. Griffin & Karl P. Claxton & Stephen J. Palmer & Mark J. Sculpher, 2011. "Dangerous omissions: the consequences of ignoring decision uncertainty," Health Economics, John Wiley & Sons, Ltd., vol. 20(2), pages 212-224, 02.
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Citations

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Cited by:
  1. Rosella Levaggi & Michele Moretto & Paolo Pertile, 2013. "The dynamics of pharmaceutical regulation and R&D investments," Working Papers 13/2013, University of Verona, Department of Economics.
  2. Rosella Levaggi & Michele Moretto & Paolo Pertile, 2010. "Static and Dynamic Efficiency of Irreversible Health Care Investments under Alternative Payment Rules," Working Papers 2010.130, Fondazione Eni Enrico Mattei.
  3. Levaggi, Rosella & Moretto, Michele & Pertile, Paolo, 2014. "Two-part payments for the reimbursement of investments in health technologies," Health Policy, Elsevier, vol. 115(2), pages 230-236.
  4. Rosella Levaggi & Michele Moretto & Paolo Pertile, 2012. "DRGs: the link between investment in technologies and appropriateness," Working Papers 31/2012, University of Verona, Department of Economics.

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