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Financing medical specialist services in the Netherlands: Welfare implications of imperfect agency

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Author Info
Kees Folmer ()
Ed Westerhout ()
Abstract

From 1995 onward the financing scheme for specialist care in the Netherlands has moved from a fee-for-service scheme to a lump-sum budget scheme. This paper analyses the economic and welfare effects of this policy change. The paper adopts a model that integrates demand and supply considerations and recognizes the potential roles of moral hazard and supplier-induced demand. The model is fully numerical, being estimated and calibrated upon data for the Dutch health care sector. The paper finds that the shift in financing regime has been welfare-reducing. The policy change induced medical specialists to lower the supply of health services which was already too low from a welfare point of view. This conclusion is robust to significant changes in major parameter values.

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Paper provided by CPB Netherlands Bureau for Economic Policy Analysis in its series CPB Discussion Papers with number 6.

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Handle: RePEc:cpb:discus:6

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Related research
Keywords: care health care medical care fee-for-service scheme lump-sum budget medical specialists moral hazard

Find related papers by JEL classification:
D60 - Microeconomics - - Welfare Economics - - - General
H21 - Public Economics - - Taxation, Subsidies, and Revenue - - - Efficiency; Optimal Taxation
I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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  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. Feldman, Roger & Dowd, Bryan, 1991. "A New Estimate of the Welfare Loss of Excess Health Insurance," American Economic Review, American Economic Association, vol. 81(1), pages 297-301, March.
  3. Ellis, Randall P & McGuire, Thomas G, 1993. "Supply-Side and Demand-Side Cost Sharing in Health Care," Journal of Economic Perspectives, American Economic Association, vol. 7(4), pages 135-51, Fall. [Downloadable!] (restricted)
  4. Erik Canton & Ed Westerhout, 1999. "A model for the Dutch pharmaceutical market," Health Economics, John Wiley & Sons, Ltd., vol. 8(5), pages 391-402.
  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. Kees Folmer & Johnny Stevens & Frank Van Tulder & Ed Westerhout, 1997. "Towards an economic model of the Dutch health care sector," Health Economics, John Wiley & Sons, Ltd., vol. 6(4), pages 351-363.
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