Budgetbereinigung zwischen Kollektiv- und Selektivvertrag: ökonomische Aspekte aus wettbewerblicher Sicht / Selective Contracting and Collectively Financed Fund: The Way of Appropriate Adjustment

The extraction of a selective contract from a collectively financed fund needs an appropriate method of adjustment. This is necessary as long as the fund guarantees basic benefits, irrespective of the contractual form of service provision. In this context externalities arise which may not be internalized by the partner of a selective contract.We look at externalities in the context of a collectively financed fund where insurers and health care providers can contract forms of managed care that need an adjustment scheme.We show that in a first-best static world, unique reimbursement schemes between collective and selective contracts are appropriate. From a dynamic perspective problems of externalities between collective and selective contracts increase due to the requirement of an enduring commitment scheme between the health care providers and the cost-payers. But some simple form of cost-sharing ideas in which the patient is also involved can help to achieve a pareto-optimal equilibrium. This commitment strategy will be easier to organise if the selective contract is connected with a process innovation. Altogether, the dynamic commitment strategy may only work if health care providers as well as cost-payers compete actively.