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

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  • 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.

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Bibliographic Info

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

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Date of creation: 2008
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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
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Keywords: Health production; Quality of health services; Discretized models;

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References

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  1. Ching-to Albert Ma & Thomas G. McGuire, 1995. "Optimal Health Insurance and Provider Payment," Papers, Boston University - Industry Studies Programme 0059, Boston University - Industry Studies Programme.
  2. A. Zabalza & C. Pissarides & M. Barton, 1980. "Social security and the choice between full-time work, part-time work and retirement," NBER Chapters, National Bureau of Economic Research, Inc, in: Econometric Studies in Public Finance, pages 245-276 National Bureau of Economic Research, Inc.
  3. Edlefsen, Lee E, 1981. "The Comparative Statics of Hedonic Price Functions and Other Nonlinear Constraints," Econometrica, Econometric Society, Econometric Society, vol. 49(6), pages 1501-20, November.
  4. T Rice & R Labelle, 1989. "Do Physicians Induce Demand for Medical Service?," Centre for Health Economics and Policy Analysis Working Paper Series, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada 18, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
  5. Harry J. Paarsch & Bruce S. Shearer, 1996. "Piece Rates, Fixed Wages, and Incentive Effects: Statistical Evidence from Payroll Records," CIRANO Working Papers, CIRANO 96s-31, CIRANO.
  6. Ben-Akiva, M. & Bolduc, D. & Bradley, M., 1993. "Estimation of Travel Choice Models with Randomly Distributed Values of Time," Papers, Laval - Recherche en Energie 9303, Laval - Recherche en Energie.
  7. 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.
  8. Grytten, Jostein & Sorensen, Rune, 2001. "Type of contract and supplier-induced demand for primary physicians in Norway," Journal of Health Economics, Elsevier, Elsevier, vol. 20(3), pages 379-393, May.
  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, Elsevier, vol. 13(4), pages 491-494.
  10. Daniel McFadden & Kenneth Train, 2000. "Mixed MNL models for discrete response," Journal of Applied Econometrics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 15(5), pages 447-470.
  11. Pauly, Mark V., 1994. "Editorial: A re-examination of the meaning and importance of supplier-induced demand," Journal of Health Economics, Elsevier, Elsevier, vol. 13(3), pages 369-372, October.
  12. 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, Institute for Fiscal Studies, vol. 21(1), pages 75-103, March.
  13. Selden, Thomas M., 1990. "A model of capitation," Journal of Health Economics, Elsevier, Elsevier, vol. 9(4), pages 397-409, December.
  14. MaCurdy, Thomas, 1992. "Work Disincentive Effects of Taxes: A Reexamination of Some Evidence," American Economic Review, American Economic Association, American Economic Association, vol. 82(2), pages 243-49, May.
  15. Bruce Shearer, 2004. "Piece Rates, Fixed Wages and Incentives: Evidence from a Field Experiment," Review of Economic Studies, Wiley Blackwell, Wiley Blackwell, vol. 71(2), pages 513-534, 04.
  16. Dranove, David, 1988. "Demand Inducement and the Physician/Patient Relationship," Economic Inquiry, Western Economic Association International, Western Economic Association International, vol. 26(2), pages 281-98, April.
  17. M. Keane & R. Moffitt, . "A structural model of multiple welfare program participation and labor supply," Institute for Research on Poverty Discussion Papers, University of Wisconsin Institute for Research on Poverty 1080-96, University of Wisconsin Institute for Research on Poverty.
  18. McGuire, Thomas G., 2000. "Physician agency," Handbook of Health Economics, Elsevier, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 9, pages 461-536 Elsevier.
  19. Baker, George P, 1992. "Incentive Contracts and Performance Measurement," Journal of Political Economy, University of Chicago Press, University of Chicago Press, vol. 100(3), pages 598-614, June.
  20. Evans, R.G. & Culyer, A.J., 1995. "Mark Pauly on Welfare Economics: Normative Rabbits from Positive Hats," Centre for Health Services and Policy Research, University of British Columbia - Centre for Health Services and Policy Research. 95:5r, University of British Columbia - Centre for Health Services and Policy Research..
  21. Fredrik Carlsen & Jostein Grytten, 1998. "More physicians: improved availability or induced demand?," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 7(6), pages 495-508.
  22. R. G. Evans & E. M. A. Parish & Floyd Sully, 1973. "Medical Productivity, Scale Effects, and Demand Generation," Canadian Journal of Economics, Canadian Economics Association, Canadian Economics Association, vol. 6(3), pages 376-93, August.
  23. Pauly, Mark V., 1994. "Reply to Roberta Labelle, Greg Stoddart and Thomas Rice," Journal of Health Economics, Elsevier, Elsevier, vol. 13(4), pages 495-496.
  24. Christopher Ferrall & Allan W. Gregory & William Tholl, 1998. "Endogenous Work Hours and Practice Patterns of Canadian Physicians," Canadian Journal of Economics, Canadian Economics Association, Canadian Economics Association, vol. 31(1), pages 1-27, February.
  25. Martin Gaynor & James B. Rebitzer & Lowell J. Taylor, 2004. "Physician Incentives in Health Maintenance Organizations," Journal of Political Economy, University of Chicago Press, University of Chicago Press, vol. 112(4), pages 915-931, August.
  26. 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.
  27. 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, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 30(2), pages 275-96, May.
  28. Abdelhak Nassiri & Lise Rochaix, 2006. "Revisiting physicians' financial incentives in Quebec: a panel system approach," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 15(1), pages 49-64.
  29. 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.
  30. 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.
  31. Eggleston, Karen, 2005. "Multitasking and mixed systems for provider payment," Journal of Health Economics, Elsevier, Elsevier, vol. 24(1), pages 211-223, January.
  32. Thomas G. McGuire & Mark V. Pauly, 1991. "Physician Response to Fee Changes with Multiple Payers," Papers, Boston University - Industry Studies Programme 0015, Boston University - Industry Studies Programme.
  33. Rochaix, Lise, 1989. "Information asymmetry and search in the market for physicians' services," Journal of Health Economics, Elsevier, Elsevier, vol. 8(1), pages 53-84, March.
  34. Pencavel, John, 1987. "Labor supply of men: A survey," Handbook of Labor Economics, Elsevier, in: O. Ashenfelter & R. Layard (ed.), Handbook of Labor Economics, edition 1, volume 1, chapter 1, pages 3-102 Elsevier.
  35. 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.
  36. De Jaegher, Kris & Jegers, Marc, 2000. "A model of physician behaviour with demand inducement," Journal of Health Economics, Elsevier, Elsevier, vol. 19(2), pages 231-258, March.
  37. Martin Gaynor & Paul Gertler, 1995. "Moral Hazard and Risk Spreading in Partnerships," RAND Journal of Economics, The RAND Corporation, vol. 26(4), pages 591-613, Winter.
  38. Brownstone, David & Train, Kenneth, 1998. "Forecasting new product penetration with flexible substitution patterns," Journal of Econometrics, Elsevier, Elsevier, vol. 89(1-2), pages 109-129, November.
  39. Edward P. Lazear, 2000. "The Power of Incentives," American Economic Review, American Economic Association, American Economic Association, vol. 90(2), pages 410-414, May.
  40. 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, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada 1994-02, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
  41. James J. Heckman, 2000. "Causal Parameters And Policy Analysis In Economics: A Twentieth Century Retrospective," The Quarterly Journal of Economics, MIT Press, MIT Press, vol. 115(1), pages 45-97, February.
  42. 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, University of Chicago Press, vol. 81(2), pages S279-88, Part II, .
  43. 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, Oxford University Press, vol. 7(0), pages 24-52, Special I.
  44. Glazer, Jacob & Glazer, Jacob & McGuire, Thomas G., 1993. "Should physicians be permitted to 'balance bill' patients?," Journal of Health Economics, Elsevier, Elsevier, vol. 12(3), pages 239-258, October.
  45. Eric Delattre & Brigitte Dormont, 2003. "Fixed fees and physician-induced demand: A panel data study on French physicians," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 12(9), pages 741-754.
  46. 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., John Wiley & Sons, Ltd., vol. 8(6), pages 497-508.
  47. 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, University of Chicago Press, vol. 86(6), pages 1103-30, December.
  48. Schaafsma, Joseph, 1994. "A new test for supplier-inducement and application to the Canadian market for dental care," Journal of Health Economics, Elsevier, Elsevier, vol. 13(4), pages 407-431.
  49. 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, University of Chicago Press, vol. 14(4), pages 703-32, October.
  50. Blundell, Richard & Macurdy, Thomas, 1999. "Labor supply: A review of alternative approaches," Handbook of Labor Economics, Elsevier, in: O. Ashenfelter & D. Card (ed.), Handbook of Labor Economics, edition 1, volume 3, chapter 27, pages 1559-1695 Elsevier.
  51. McGuire, Thomas G. & Pauly, Mark V., 1991. "Physician response to fee changes with multiple payers," Journal of Health Economics, Elsevier, Elsevier, vol. 10(4), pages 385-410.
  52. Berry, Steven & Levinsohn, James & Pakes, Ariel, 1995. "Automobile Prices in Market Equilibrium," Econometrica, Econometric Society, Econometric Society, vol. 63(4), pages 841-90, July.
  53. repec:fth:stanho:e-90-11 is not listed on IDEAS
  54. Carlsen, Fredrik & Grytten, Jostein, 2000. "Consumer satisfaction and supplier induced demand," Journal of Health Economics, Elsevier, Elsevier, vol. 19(5), pages 731-753, September.
  55. Fuchs, Victor R., 1986. "Physician-induced demand: A parable," Journal of Health Economics, Elsevier, Elsevier, vol. 5(4), pages 367-367, December.
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Citations

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Cited by:
  1. Etienne Dumont & Bernard Fortin & Nicolas Jacquemet & Bruce Shearer, 2007. "Physicians' Multitasking and Incentives: Empirical Evidence from a Natural Experiment," Cahiers de recherche, CIRPEE 0745, CIRPEE.
  2. Marie Allard & Izabela Jelovac & Pierre-Thomas Léger, 2010. "Physicians self selection of a payment mechanism: Capitation versus fee-for-service," Post-Print, HAL halshs-00523370, HAL.
  3. Bardey, David & Cremer, Helmuth & Lozachmeur, Jean-Marie, 2011. "Doctors' remuneration schemes and hospital competition in two-sided markets with common network externalities," IDEI Working Papers, Institut d'Économie Industrielle (IDEI), Toulouse 628, Institut d'Économie Industrielle (IDEI), Toulouse, revised Jul 2011.
  4. Bernard Fortin & Nicolas Jacquemet & Bruce S. Shearer, 2010. "Labour Supply, Work Effort and Contract Choice: Theory and Evidence on Physicians," CIRANO Working Papers, CIRANO 2010s-40, CIRANO.
  5. repec:hal:journl:halshs-00305308 is not listed on IDEAS
  6. Weeks, William B. & Paraponaris, Alain & Ventelou, Bruno, 2013. "Sex-based differences in income and response to proposed financial incentives among general practitioners in France," Health Policy, Elsevier, Elsevier, vol. 113(1), pages 199-205.
  7. Marie Allard & Izabela Jelovac & Pierre-Thomas Léger, 2014. "Payment mechanism and GP self-selection: capitation versus fee for service," International Journal of Health Care Finance and Economics, Springer, Springer, vol. 14(2), pages 143-160, June.

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