Advanced Search
MyIDEAS: Login to save this paper or follow this series

Policy Analysis in the health-services market: accounting for quality and quantity

Contents:

Author Info

  • Bernard Fortin

    (CIRPEE - Universite Laval (Quebec) - Canada)

  • Nicolas Jacquemet

    ()
    (CES - Centre d'économie de la Sorbonne - CNRS : UMR8174 - Université Paris I - Panthéon-Sorbonne, EEP-PSE - Ecole d'Économie de Paris - Paris School of Economics - Ecole d'Économie de Paris)

  • Bruce Shearer

    (CIRPEE - Universite Laval (Quebec) - Canada)

Abstract

We provide a theoretical and empirical framework for evaluating the eects of policy reforms on physician labor supply. We argue that any policy evaluation must account for both the quality and the quantity of services provided. The introduction of quality into the analysis has implications for both the theoretical and empirical analysis of labor supply, and consequently policy evaluation. In particular, endogenous quality choices introduce non- linearities into the budget constraint since the marginal return to an hour of work depends on the quality of services provided. We illustrate by considering a particular example: the recent reform in compensation contracts for specialist physicians in the province of Quebec (Canada). Prior to 1999, most Quebec specialist physicians were paid fee-for-service con- tracts; they received a piece rate for each clinical service provided. In 1999, the government introduced a mixed remuneration system, under which physicians received a base (half-daily or daily) wage, independent of services provided, and a reduced fee-for-service. Moreover, the government allowed physicians to choose their contract. We derive theoretical results for the eect of the reform on the quantity and quality of services supplied by analyzing "local" prices and virtual income. We propose discretizing the choice set as an empirical approach to policy evaluation in the presence of non-linear budget constraints.

Download Info

If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
File URL: http://halshs.archives-ouvertes.fr/docs/00/30/53/09/PDF/RM-Theo-AES-WP.pdf
Download Restriction: no

Bibliographic Info

Paper provided by HAL in its series Université Paris1 Panthéon-Sorbonne (Post-Print and Working Papers) with number halshs-00305309.

as in new window
Length:
Date of creation: 2008
Date of revision:
Publication status: Published, Annales d'Economie et Statistiques, 2008, 91-92, 287-313
Handle: RePEc:hal:cesptp:halshs-00305309

Note: View the original document on HAL open archive server: http://halshs.archives-ouvertes.fr/halshs-00305309
Contact details of provider:
Web page: http://hal.archives-ouvertes.fr/

Related research

Keywords: Health production; Quality of health services; Discretized models;

References

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.:
as in new window
  1. Eggleston, Karen, 2005. "Multitasking and mixed systems for provider payment," Journal of Health Economics, Elsevier, vol. 24(1), pages 211-223, January.
  2. Selden, Thomas M., 1990. "A model of capitation," Journal of Health Economics, Elsevier, vol. 9(4), pages 397-409, December.
  3. McGuire, Thomas G. & Pauly, Mark V., 1991. "Physician response to fee changes with multiple payers," Journal of Health Economics, Elsevier, vol. 10(4), pages 385-410.
  4. Schaafsma, Joseph, 1994. "A new test for supplier-inducement and application to the Canadian market for dental care," Journal of Health Economics, Elsevier, vol. 13(4), pages 407-431.
  5. Dranove, David, 1988. "Demand Inducement and the Physician/Patient Relationship," Economic Inquiry, Western Economic Association International, vol. 26(2), pages 281-98, April.
  6. Brownstone, David & Train, Kenneth, 1999. "Forecasting new product penetration with flexible substitution patterns," University of California Transportation Center, Working Papers qt1j6814b3, University of California Transportation Center.
  7. Thomas G. McGuire & Mark V. Pauly, 1991. "Physician Response to Fee Changes with Multiple Payers," Papers 0015, Boston University - Industry Studies Programme.
  8. Paarsch, Harry J. & Shearer, Bruce, 1996. "Piece Rates, Fixed Wages, and Incentive Effects: Statistical Evidence from Payroll Records," Cahiers de recherche 9623, Université Laval - Département d'économique.
  9. Labelle, Roberta & Stoddart, Greg & Rice, Thomas, 1994. "Editorial: Response to Pauly on a re-examination of the meaning and importance of supplier-induced demand," Journal of Health Economics, Elsevier, vol. 13(4), pages 491-494.
  10. T Rice & R Labelle, 1989. "Do Physicians Induce Demand for Medical Service?," Centre for Health Economics and Policy Analysis Working Paper Series 18, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
  11. 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.
  12. Burtless, Gary & Hausman, Jerry A, 1978. "The Effect of Taxation on Labor Supply: Evaluating the Gary Negative Income Tax Experiments," Journal of Political Economy, University of Chicago Press, vol. 86(6), pages 1103-30, December.
  13. Jonathan Gruber & Maria Owings, 1996. "Physician Financial Incentives and Cesarean Section Delivery," RAND Journal of Economics, The RAND Corporation, vol. 27(1), pages 99-123, Spring.
  14. Thomas MaCurdy & David Green & Harry Paarsch, 1990. "Assessing Empirical Approaches for Analyzing Taxes and Labor Supply," Journal of Human Resources, University of Wisconsin Press, vol. 25(3), pages 415-490.
  15. Edlefsen, Lee E, 1981. "The Comparative Statics of Hedonic Price Functions and Other Nonlinear Constraints," Econometrica, Econometric Society, vol. 49(6), pages 1501-20, November.
  16. Grytten, Jostein & Sorensen, Rune, 2001. "Type of contract and supplier-induced demand for primary physicians in Norway," Journal of Health Economics, Elsevier, vol. 20(3), pages 379-393, May.
  17. Arthur van Soest, 1995. "Structural Models of Family Labor Supply: A Discrete Choice Approach," Journal of Human Resources, University of Wisconsin Press, vol. 30(1), pages 63-88.
  18. Becker, Gary S & Lewis, H Gregg, 1973. "On the Interaction between the Quantity and Quality of Children," Journal of Political Economy, University of Chicago Press, vol. 81(2), pages S279-88, Part II, .
  19. Holmstrom, Bengt & Milgrom, Paul, 1991. "Multitask Principal-Agent Analyses: Incentive Contracts, Asset Ownership, and Job Design," Journal of Law, Economics and Organization, Oxford University Press, vol. 7(0), pages 24-52, Special I.
  20. Michael P. Keane & Robert Moffitt, 1995. "A structural model of multiple welfare program participation and labor supply," Working Papers 557, Federal Reserve Bank of Minneapolis.
  21. Culyer, Anthony J. & Evans, Robert G., 1996. "Mark Pauly on welfare economics: Normative rabbits from positive hats," Journal of Health Economics, Elsevier, vol. 15(2), pages 243-251, April.
  22. Pauly, Mark V., 1994. "Editorial: A re-examination of the meaning and importance of supplier-induced demand," Journal of Health Economics, Elsevier, vol. 13(3), pages 369-372, October.
  23. De Jaegher, Kris & Jegers, Marc, 2000. "A model of physician behaviour with demand inducement," Journal of Health Economics, Elsevier, vol. 19(2), pages 231-258, March.
  24. James J. Heckman, 2000. "Causal Parameters And Policy Analysis In Economics: A Twentieth Century Retrospective," The Quarterly Journal of Economics, MIT Press, vol. 115(1), pages 45-97, February.
  25. MaCurdy, Thomas, 1992. "Work Disincentive Effects of Taxes: A Reexamination of Some Evidence," American Economic Review, American Economic Association, vol. 82(2), pages 243-49, May.
  26. Keane, Michael & Wolpin, Kenneth, 1997. "Introduction to the JBES Special Issue on Structural Estimation in Applied Microeconomics," MPRA Paper 55136, University Library of Munich, Germany.
  27. Richard Blundell & Thomas MaCurdy, 1998. "Labour supply: a review of alternative approaches," IFS Working Papers W98/18, Institute for Fiscal Studies.
  28. Glazer, Jacob & Glazer, Jacob & McGuire, Thomas G., 1993. "Should physicians be permitted to 'balance bill' patients?," Journal of Health Economics, Elsevier, vol. 12(3), pages 239-258, October.
  29. Eric Delattre & Brigitte Dormont, 2003. "Fixed fees and physician-induced demand: A panel data study on French physicians," Health Economics, John Wiley & Sons, Ltd., vol. 12(9), pages 741-754.
  30. Edward P. Lazear, 2000. "The Power of Incentives," American Economic Review, American Economic Association, vol. 90(2), pages 410-414, May.
  31. Bolduc, Denis & Fortin, Bernard & Fournier, Marc-Andre, 1996. "The Effect of Incentive Policies on the Practice Location of Doctors: A Multinomial Probit Analysis," Journal of Labor Economics, University of Chicago Press, vol. 14(4), pages 703-32, October.
  32. A. Zabalza & C. Pissarides & M. Barton, 1980. "Social security and the choice between full-time work, part-time work and retirement," NBER Chapters, in: Econometric Studies in Public Finance, pages 245-276 National Bureau of Economic Research, Inc.
  33. Abdelhak Nassiri & Lise Rochaix, 2006. "Revisiting physicians' financial incentives in Quebec: a panel system approach," Health Economics, John Wiley & Sons, Ltd., vol. 15(1), pages 49-64.
  34. Gaynor, M. & Gertler, P., 1996. "Moral hazard and Risk Speading in Partnerships," Papers 96-09, RAND - Reprint Series.
  35. Blomquist, N Soren, 1989. "Comparative Statics for Utility Maximization Models with Nonlinear Budget Constraints," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 30(2), pages 275-96, May.
  36. R. G. Evans & E. M. A. Parish & Floyd Sully, 1973. "Medical Productivity, Scale Effects, and Demand Generation," Canadian Journal of Economics, Canadian Economics Association, vol. 6(3), pages 376-93, August.
  37. 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.
  38. Bruce Shearer, 2004. "Piece Rates, Fixed Wages and Incentives: Evidence from a Field Experiment," Review of Economic Studies, Wiley Blackwell, vol. 71(2), pages 513-534, 04.
  39. Baker, George P, 1992. "Incentive Contracts and Performance Measurement," Journal of Political Economy, University of Chicago Press, vol. 100(3), pages 598-614, June.
  40. Fredrik Carlsen & Jostein Grytten, 1998. "More physicians: improved availability or induced demand?," Health Economics, John Wiley & Sons, Ltd., vol. 7(6), pages 495-508.
  41. Pauly, Mark V., 1994. "Reply to Roberta Labelle, Greg Stoddart and Thomas Rice," Journal of Health Economics, Elsevier, vol. 13(4), pages 495-496.
  42. Rune J. S�rensen & Jostein Grytten, 1999. "Competition and supplier-induced demand in a health care system with fixed fees," Health Economics, John Wiley & Sons, Ltd., vol. 8(6), pages 497-508.
  43. Pencavel, John, 1987. "Labor supply of men: A survey," Handbook of Labor Economics, in: O. Ashenfelter & R. Layard (ed.), Handbook of Labor Economics, edition 1, volume 1, chapter 1, pages 3-102 Elsevier.
  44. Ben-Akiva, M. & Bolduc, D. & Bradley, M., 1993. "Estimation of Travel Choice Models with Randomly Distributed Values of Time," Papers 9303, Laval - Recherche en Energie.
  45. Rochaix, Lise, 1989. "Information asymmetry and search in the market for physicians' services," Journal of Health Economics, Elsevier, vol. 8(1), pages 53-84, March.
  46. Fuchs, Victor R., 1986. "Physician-induced demand: A parable," Journal of Health Economics, Elsevier, vol. 5(4), pages 367-367, December.
  47. Daniel McFadden & Kenneth Train, 2000. "Mixed MNL models for discrete response," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 15(5), pages 447-470.
  48. repec:fth:stanho:e-90-11 is not listed on IDEAS
  49. Harry J. Paarsch & Bruce S. Shearer, 1999. "The Response of Worker Effort to Piece Rates: Evidence from the British Columbia Tree-Planting Industry," Journal of Human Resources, University of Wisconsin Press, vol. 34(4), pages 643-667.
  50. Christopher Ferrall & Allan W. Gregory & William Tholl, 1998. "Endogenous Work Hours and Practice Patterns of Canadian Physicians," Canadian Journal of Economics, Canadian Economics Association, vol. 31(1), pages 1-27, February.
  51. Richard Blundell & Alan Duncan & Julian McCrae & Costas Meghir, 2000. "The labour market impact of the working families’ tax credit," Fiscal Studies, Institute for Fiscal Studies, vol. 21(1), pages 75-103, March.
  52. Martin Gaynor & James B. Rebitzer & Lowell J. Taylor, 2004. "Physician Incentives in Health Maintenance Organizations," Journal of Political Economy, University of Chicago Press, vol. 112(4), pages 915-931, August.
  53. Berry, Steven & Levinsohn, James & Pakes, Ariel, 1995. "Automobile Prices in Market Equilibrium," Econometrica, Econometric Society, vol. 63(4), pages 841-90, July.
  54. Carlsen, Fredrik & Grytten, Jostein, 2000. "Consumer satisfaction and supplier induced demand," Journal of Health Economics, Elsevier, vol. 19(5), pages 731-753, September.
  55. B Hutchison & S Birch & J Hurley & J Lomas & F Stratford-Devai, 1994. "Do Physician Payment Mechanisms Affect Hospital Utilization? A Study of Health Service Organizations in Ontario," Centre for Health Economics and Policy Analysis Working Paper Series 1994-02, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
Full references (including those not matched with items on IDEAS)

Citations

Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
as in new window

Cited by:
  1. repec:hal:journl:halshs-00305308 is not listed on IDEAS
  2. Bernard Fortin & Nicolas Jacquemet & Bruce S. Shearer, 2010. "Labour Supply, Work Effort and Contract Choice: Theory and Evidence on Physicians," CIRANO Working Papers 2010s-40, CIRANO.
  3. Etienne Dumont & Bernard Fortin & Nicolas Jacquemet & Bruce S. Shearer, 2008. "Physicians’ Multitasking and Incentives: Empirical Evidence from a Natural Experiment," CIRANO Working Papers 2008s-20, CIRANO.
  4. Marie Allard & Izabela Jelovac & Pierre-Thomas Léger, 2010. "Physicians self selection of a payment mechanism: Capitation versus fee-for-service," Post-Print halshs-00523370, HAL.
  5. Etienne Dumont & Bernard Fortin & Nicolas Jacquemet & Bruce Shearer, 2008. "Physicians' Multitasking and Incentives: Empirical Evidence from a Natural Experiment," Université Paris1 Panthéon-Sorbonne (Post-Print and Working Papers) halshs-00305308, HAL.

Lists

This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.

Statistics

Access and download statistics

Corrections

When requesting a correction, please mention this item's handle: RePEc:hal:cesptp:halshs-00305309. See general information about how to correct material in RePEc.

For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (CCSD).

If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

If references are entirely missing, you can add them using this form.

If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.

If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.

Please note that corrections may take a couple of weeks to filter through the various RePEc services.