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Policy Analysis in the Health-Services Market: Accounting for Quality and Quantity

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  • Bernard Fortin
  • Nicolas Jacquemet
  • Bruce Shearer

Abstract

We provide a theoretical and empirical framework for evaluating the effects 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 contracts; 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 effect 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 CIRPEE in its series Cahiers de recherche with number 0807.

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Date of creation: 2008
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Handle: RePEc:lvl:lacicr:0807

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

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Cited by:
  1. repec:hal:journl:halshs-00305308 is not listed on IDEAS
  2. Dumont, Etienne & Fortin, Bernard & Jacquemet, Nicolas & Shearer, Bruce S., 2007. "Physicians' Multitasking and Incentives: Empirical Evidence from a Natural Experiment," IZA Discussion Papers 3229, Institute for the Study of Labor (IZA).
  3. Bernard Fortin & Nicolas Jacquemet & Bruce Shearer, 2010. "Labour Supply, Work Effort and Contract Choice: Theory and Evidence on Physicians," Cahiers de recherche 1034, CIRPEE.
  4. 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 628, Institut d'Économie Industrielle (IDEI), Toulouse, revised Jul 2011.
  5. Marie Allard & Izabela Jelovac & Pierre-Thomas Léger, 2010. "Physicians self selection of a payment mechanism: Capitation versus fee-for-service," Working Papers 1024, Groupe d'Analyse et de Théorie Economique (GATE), Centre national de la recherche scientifique (CNRS), Université Lyon 2, Ecole Normale Supérieure.
  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, vol. 113(1), pages 199-205.

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