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Health Service Gatekeepers

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Author Info
James M. Malcomson () (University of Oxford)

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Abstract

Incentive contracts for gatekeepers who control patient access to specialist medical services provide too-weak incentives to investigate cost further when the expected cost of treatment is greater than the benefit. Making gatekeepers residual claimants with a fixed fee from which treatment costs must be met (as with full insurers who are themselves gatekeepers) provides too-strong incentives when the expected cost is less than the benefit. Giving patients the choice between a gatekeeper with an incentive contract and one without is unstable. With one scenario, patients always prefer the latter. With another, patients have incentives to acquire information that makes incentive contracts ineffective can switch between a prisoners' dilemma and a coordination game.

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Publisher Info
Article provided by The RAND Corporation in its journal RAND Journal of Economics.

Volume (Year): 35 (2004)
Issue (Month): 2 (Summer)
Pages: 401-421
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Handle: RePEc:rje:randje:v:35:y:2004:2:p:401-421

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References listed on IDEAS
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
  1. Ellis, Randall P. & McGuire, Thomas G., 1990. "Optimal payment systems for health services," Journal of Health Economics, Elsevier, vol. 9(4), pages 375-396, December. [Downloadable!] (restricted)
  2. David M. Cutler & Richard J. Zeckhauser, 1999. "The Anatomy of Health Insurance," NBER Working Papers 7176, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
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  3. Propper, Carol & Croxson, Bronwyn & Shearer, Arran, 2002. "Waiting times for hospital admissions: the impact of GP fundholding," Journal of Health Economics, Elsevier, vol. 21(2), pages 227-252, March. [Downloadable!] (restricted)
    Other versions:
  4. 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.
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  5. Ellis, Randall P. & McGuire, Thomas G., 1986. "Provider behavior under prospective reimbursement : Cost sharing and supply," Journal of Health Economics, Elsevier, vol. 5(2), pages 129-151, June. [Downloadable!] (restricted)
  6. Ching-To Albert Ma & Michael H. Riordan, 2002. "Health Insurance, Moral Hazard, and Managed Care," Journal of Economics & Management Strategy, Blackwell Publishing, vol. 11(1), pages 81-107, 03. [Downloadable!] (restricted)
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  7. Glied, Sherry, 2000. "Managed care," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 13, pages 707-753 Elsevier. [Downloadable!] (restricted)
  8. Scott, Anthony, 2000. "Economics of general practice," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 22, pages 1175-1200 Elsevier. [Downloadable!] (restricted)
  9. Gravelle, Hugh, 1999. "Capitation contracts: access and quality," Journal of Health Economics, Elsevier, vol. 18(3), pages 315-340, June. [Downloadable!] (restricted)
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Cited by:
(explanations, Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.)

  1. Jennifer Arlen & W.Bentley Macleod, 2004. "Torts, Expertise, and Authority: Liability of Physicians and Managed Care Organizations," Working Papers 04-26, New York University, Leonard N. Stern School of Business, Department of Economics. [Downloadable!]
    Other versions:
  2. James Malcomson, 2005. "Supplier Discretion over Provision: Theory and an Application to Medical Care," CESifo Working Paper Series CESifo Working Paper No. , CESifo Group Munich. [Downloadable!]
    Other versions:
  3. Paula González, 2008. "Gatekeeping versus Direct-Access when Patient Information Matters," Working Papers 2008-05, FEDEA. [Downloadable!]
  4. Paula González, 2006. "The Gatekeeping Role of General Practitioners. Does Patients' Information Matter?," Working Papers 06.09, Universidad Pablo de Olavide, Department of Economics. [Downloadable!]
    Other versions:
  5. Tor Iversen & Ching-to Albert Ma, . "Market Conditions and General Practitioners' Referrals," Boston University - Department of Economics - Working Papers Series wp2009-009, Boston University - Department of Economics. [Downloadable!]
  6. Kurt R. Brekke & Robert Nuscheler & Odd Rune Straume, 2005. "Gatekeeping in Health Care," CESifo Working Paper Series CESifo Working Paper No. , CESifo Group Munich. [Downloadable!]
    Other versions:
  7. F. Barigozzi & R. Levaggi, 2005. "New Developments in Physician Agency: the Role of Patient Information," Working Papers 550, Dipartimento Scienze Economiche, Universita' di Bologna. [Downloadable!]
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