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Reforming Incentive Schemes Under Political Constraints: The Physician Agency

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  • Demange, Gabrielle
  • Geoffard, Pierre-Yves

Abstract

The present Paper investigates political constraints that may impair attempts to reform payment schemes of a given profession. When the good produced (e.g. health care) is imperfectly observable by the payer (e.g. health insurance), asymmetries of information limit the possibility to base payments upon outcome (e.g. quality of care), and payment schemes must be based on some verifiable input (e.g. number of acts). The model is applied, but not restricted to, the physician agency. Political constraints are defined as the necessity to obtain the consent of a large proportion of providers to a given reform of their reward schemes. Second-best efficient reforms, which take into account the welfare cost of such political constraints, induce additional spending due to an excessive quality of outcome. More strikingly, no reform, which imposes to shift away from current payment schemes, may be feasible when practice is highly heterogeneous, and the proportion of producers who need to agree to a reform proposal is large. Since heterogeneity of producers’ practice is a key issue in terms of reforms’ acceptability, we also study whether a menu of contracts may be a way to alleviate the political constraints. In most cases, this requires the introduction of a ‘quality compensation’ scheme that compensates for quality variations across different competing contracts.

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Paper provided by C.E.P.R. Discussion Papers in its series CEPR Discussion Papers with number 3589.

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Date of creation: Oct 2002
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Handle: RePEc:cpr:ceprdp:3589

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Keywords: health care reform; physicians' payment scheme;

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  1. Ma, Ching-to Albert & McGuire, Thomas G, 1997. "Optimal Health Insurance and Provider Payment," American Economic Review, American Economic Association, vol. 87(4), pages 685-704, September.
  2. Holly, Alberto & Gardiol, Lucien & Domenighetti, Gianfranco & Brigitte Bisig, 1998. "An econometric model of health care utilization and health insurance in Switzerland," European Economic Review, Elsevier, vol. 42(3-5), pages 513-522, May.
  3. McGuire, Thomas G., 2000. "Physician agency," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 9, pages 461-536 Elsevier.
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Cited by:
  1. P. Bontems & N. Turpin & Gilles Rotillon, 2003. "Acceptibility constraints and self-selecting agri-environmental policies," THEMA Working Papers 2003-14, THEMA (THéorie Economique, Modélisation et Applications), Université de Cergy-Pontoise.
  2. Bontems, Philippe & Rotillon, Gilles & Turpin, Nadine, 2005. "Acceptable Reforms of Agri-Environmental Policies," 2005 Annual meeting, July 24-27, Providence, RI 19150, American Agricultural Economics Association (New Name 2008: Agricultural and Applied Economics Association).
  3. David Bardey & Jean-Charles Rochet, 2010. "Competition Among Health Plans: A Two-Sided Market Approach," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 19(2), pages 435-451, 06.

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