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Physician reimbursement, time-consistency and the quality of care


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  • Nuscheler, Robert


We use a model of horizontal and vertical differentiation to study physicians’ incentives to provide quality in the physician-patient relationship under price regulation. If the price is the only regulatory variable, the social planner cannot implement the first-best policy. Moreover, the second-best policy is time inconsistent. Excess entry and firstbest efficient total quality provision is observed in the game without commitment. Allowing physicians to compete in prices does not solve the commitment problem since the competitive solution coincides with the time consistent outcome. In the median voter equilibrium the time consistency problem is more severe. -- In einem Modell der horizontalen und vertikalen Produktdifferenzierung werden die ärztlichen Anreize, medizinische Qualität bereitzustellen, in Gegenwart von Preisregulierung untersucht. In Gegenwart zweier strategischer Variablen kann ein ausschließlich preisregulierender sozialer Planer das erstbeste Wohlfahrtsoptimum nicht implementieren. Darüber hinaus ist das zweitbeste Wohlfahrtsoptimum nicht zeitkonsistent. Mit zeitkonsistenter Regulierung ergibt sich eine effiziente Qualität medizinischer Leistungen, jedoch eine zu hohe Arztdichte. Preiswettbewerb zwischen den Ärzten führt zur selben Allokation wie bei zeitkonsistenter Regulierung. Die Probleme des Gesundheitsmarktes lassen sich somit nicht durch mehr Wettbewerb lösen. Das Zeitkonsistenzproblem ist noch gravierender, wenn über den Preis durch eine Mehrheitsabstimmung entschieden wird. Wendet man das Modell auf den deutschen Gesundheitsmarkt an, so zeigt sich, dass die kassenärztliche Zulassung – trotz Bedarfsplanung – zu großzügig ist.

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Paper provided by Social Science Research Center Berlin (WZB) in its series Discussion Papers, Research Unit: Market Processes and Governance with number FS IV 02-16.

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Date of creation: 2002
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Handle: RePEc:zbw:wzbmpg:fsiv0216

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Keywords: Economics of health care markets; time consistency; price regulation; quality competition; spatial competition;

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  1. Novshek, William, 1980. "Equilibrium in simple spatial (or differentiated product) models," Journal of Economic Theory, Elsevier, Elsevier, vol. 22(2), pages 313-326, April.
  2. Neven, D. & Thisse, J-F., 1989. "On Quality And Variety Competition," CORE Discussion Papers, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE) 1989020, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
  3. Gravelle, Hugh, 1999. "Capitation contracts: access and quality," Journal of Health Economics, Elsevier, Elsevier, vol. 18(3), pages 315-340, June.
  4. GABSZEWICZ, Jean J. & THISSE, Jacques-François, . "Entry (and exit) in a differentiated industry," CORE Discussion Papers RP, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE) -400, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
  5. Franz Benstetter & Achim Wambach, 2001. "Strategic Interaction in the Market for Physician Services: The Treadmill Effect in a Fixed Budget System," CESifo Working Paper Series 427, CESifo Group Munich.
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