Reforming incentive schemes under political constraints : The physician agency
AbstractThe 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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Bibliographic InfoPaper provided by DELTA (Ecole normale supérieure) in its series DELTA Working Papers with number 2002-14.
Date of creation: 2002
Date of revision:
Other versions of this item:
- Gabrielle DEMANGE & Pierre-Yves GEOFFARD, 2006. "Reforming incentive schemes under political constraints: the physician agency," Annales d'Economie et de Statistique, ENSAE, issue 83-84, pages 221-250.
- Demange, Gabrielle & Geoffard, Pierre-Yves, 2002. "Reforming Incentive Schemes Under Political Constraints: The Physician Agency," CEPR Discussion Papers 3589, C.E.P.R. Discussion Papers.
- Gabrielle Demange & Pierre Yves Geoffard, 2006. "Reforming incentive schemes under political constraints: The physician agency," Post-Print halshs-00581377, HAL.
- D73 - Microeconomics - - Analysis of Collective Decision-Making - - - Bureaucracy; Administrative Processes in Public Organizations; Corruption
- I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
- L10 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - General
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