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Prospective payment system : consequences for hospital-physician interactions in the private sector

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  • Ana, MAULEON

    (UNIVERSITE CATHOLIQUE DE LOUVAIN, Institut de Recherches Economiques et Sociales (IRES) and CRESGE-LABORES, Université Catholique de Lille-France)

  • Laurent, COUDEVILLE

    (CRESGE-LABORES, Université Catholique de Lille-France)

  • Benoit, DERVAUX

    (CRESGE-LABORES, Université Catholique de Lille-France)

Abstract

In 2004, French health authorities plan to introduce a prospective payment system for hospitals delivering acute care based on the DRG classification system. In this paper, we analyze the consequences of this switch from a retrospective to a prospective payment system on the ability of physicians and hospital managers to coordinate their activity in the production of hospital stays. Our analysis follows those of Dor and Watson (1995) and Custer et al. (1990) but is adapted to the context of the French hospital private sector. Different types of interactions are considered : non-cooperative, dominant-reactive, and cooperative. The main result of this analysis is that, in a context in which average per-patient fees are maintained, the change of payment system is potentially gainful for both partners. Although their fees are not concerned by the reform, physicians are even in a better position than hospitals tot ake advantage of the change of payment system. A minimum level of coordination is nevertheless required, i.e. either cooperative or dominant-reactive interactions. Furthermore, two elements limits the importance of these potential gains : these are only one-shot gains and hence depend on the ability to reduce the length of hospital stays. Finally, some extensions regarding competition between public and private hospitals and negotiation issues are discussed.

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Bibliographic Info

Paper provided by Université catholique de Louvain, Institut de Recherches Economiques et Sociales (IRES) in its series Discussion Papers (IRES - Institut de Recherches Economiques et Sociales) with number 2004011.

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Date of creation: 01 Apr 2004
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Handle: RePEc:ctl:louvir:2004011

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Keywords: prospective payment system; retrospective payment system; physician behabivour; for-profit hospitals;

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  1. Pauly, Mark V & Redisch, Michael, 1973. "The Not-For-Profit Hospital as a Physicians' Cooperative," American Economic Review, American Economic Association, vol. 63(1), pages 87-99, March.
  2. Michel MOUGEOT, 2000. "La tarification hospitalière : de l'enveloppe globale à la concurrence par comparaison," Annales d'Economie et de Statistique, ENSAE, issue 58, pages 195-213.
  3. Chalkley, M. & Malcomson, J.M., 1995. "Contracting for health services with unmonitored quality," Discussion Paper Series In Economics And Econometrics 9510, Economics Division, School of Social Sciences, University of Southampton.
  4. Foster, Richard W., 1985. "Cost-shifting under cost reimbursement and prospective payment," Journal of Health Economics, Elsevier, vol. 4(3), pages 261-271, September.
  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.
  6. Ching-to Albert Ma, 1994. "Health Care Payment Systems: Cost and Quality Incentives," Papers 0047, Boston University - Industry Studies Programme.
  7. Custer, William S. & Moser, James W. & Musacchio, Robert A. & Willke, Richard J., 1990. "The production of health care services and changing hospital reimbursement : The role of hospital-medical staff relationships," Journal of Health Economics, Elsevier, vol. 9(2), pages 167-192, September.
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Cited by:
  1. CRAINICH, David & LELEU, Hervé & MAULEON, Ana, . "Hospital's activity-based financing system and manager: physician interaction," CORE Discussion Papers RP -2323, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).

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