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Reimbursing Health Plans and Health Providers: Efficiency in Production versus Selection

Citations

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Cited by:

  1. Juven, Pierre-André, 2015. "Concurrence par comparaison et transformations quasi-marchandes," Revue de la Régulation - Capitalisme, institutions, pouvoirs, Association Recherche et Régulation, vol. 17.
  2. Suthathip Yaisawarng & James F. Burgess, 2006. "Performance‐based budgeting in the public sector: an illustration from the VA health care system," Health Economics, John Wiley & Sons, Ltd., vol. 15(3), pages 295-310, March.
  3. Bardey, David & De Donder, Philippe & Mantilla, César, 2019. "How is the trade-off between adverse selection and discrimination risk affected by genetic testing? Theory and experiment," Journal of Health Economics, Elsevier, vol. 68(C).
  4. John F. Cogan & R. Glenn Hubbard & Daniel P. Kessler, 2008. "The Effect of Medicare Coverage for the Disabled on the Market for Private Insurance," NBER Working Papers 14309, National Bureau of Economic Research, Inc.
  5. Cots, Francesc & Elvira, David & Castells, Xavier & Dalmau, Eulalia, 2000. "Medicare's DRG-weights in a European environment: the Spanish experience," Health Policy, Elsevier, vol. 51(1), pages 31-47, February.
  6. Batata, Amber, 2004. "The effect of HMOs on fee-for-service health care expenditures: evidence from medicare revisited," Journal of Health Economics, Elsevier, vol. 23(5), pages 951-963, September.
  7. Laurent Gobillon & Carine Milcent, 2013. "Spatial disparities in hospital performance," Journal of Economic Geography, Oxford University Press, vol. 13(6), pages 1013-1040, November.
  8. Martin Gaynor & James Rebitzer & Lowell Taylor, "undated". "Incentives in HMOs," GSIA Working Papers 2003-E21, Carnegie Mellon University, Tepper School of Business.
  9. Shuli Brammli-Greenberg & Jacob Glazer & Ruth Waitzberg, 2019. "Modest risk-sharing significantly reduces health plans’ incentives for service distortion," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(9), pages 1359-1374, December.
  10. Schokkaert, Erik & Van de Voorde, Carine, 2009. "Direct versus indirect standardization in risk adjustment," Journal of Health Economics, Elsevier, vol. 28(2), pages 361-374, March.
  11. Schokkaert, Erik & Van de Voorde, Carine, 2004. "Risk selection and the specification of the conventional risk adjustment formula," Journal of Health Economics, Elsevier, vol. 23(6), pages 1237-1259, November.
  12. Zack Cooper & Stuart V Craig & Martin Gaynor & John Van Reenen, 2019. "The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 134(1), pages 51-107.
  13. Jack, William, 2001. "Controlling selection incentives when health insurance contracts are endogenous," Journal of Public Economics, Elsevier, vol. 80(1), pages 25-48, April.
  14. Shen, Yujing & Ellis, Randall P., 2002. "Cost-minimizing risk adjustment," Journal of Health Economics, Elsevier, vol. 21(3), pages 515-530, May.
  15. Ching‐To Albert Ma & Thomas G. Mcguire, 2002. "Network Incentives in Managed Health Care," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 11(1), pages 1-35, March.
  16. Karen Eggleston & Randall P. Ellis & Mingshan Lu, 2007. "Prevention and Dynamic Risk Adjustment," Boston University - Department of Economics - Working Papers Series WP2007-023, Boston University - Department of Economics.
  17. Schmid, Christian P.R. & Beck, Konstantin, 2016. "Re-insurance in the Swiss health insurance market: Fit, power, and balance," Health Policy, Elsevier, vol. 120(7), pages 848-855.
  18. Hammer, Jeffrey & Jack, William, 2002. "Designing incentives for rural health care providers in developing countries," Journal of Development Economics, Elsevier, vol. 69(1), pages 297-303, October.
  19. Wynand Ven & Gerrit Hamstra & Richard Kleef & Mieke Reuser & Piet Stam, 2023. "The goal of risk equalization in regulated competitive health insurance markets," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(1), pages 111-123, February.
  20. Peter Zweifel & Friedrich Breyer, 2012. "The Economics of Social Health Insurance," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 12, Edward Elgar Publishing.
  21. Braendle, Thomas & Colombier, Carsten, 2016. "What drives public health care expenditure growth? Evidence from Swiss cantons, 1970–2012," Health Policy, Elsevier, vol. 120(9), pages 1051-1060.
  22. David Bardey & Helmuth Cremer & Jean-Marie Lozachmeur, 2011. "Doctors´ remuneration schemes and hospital competition in two-sided markets with common network externalities," Documentos de Trabajo 8848, Universidad del Rosario.
  23. Karen Eggleston & Chee-Ruey Hsieh, 2004. "Health Care Payment Incentives: A Comparative Analysis of Reforms in Taiwan, Korea and China," Discussion Papers Series, Department of Economics, Tufts University 0402, Department of Economics, Tufts University.
  24. Amir Shmueli, 2001. "The effect of health on acute care supplemental insurance ownership: an empirical analysis," Health Economics, John Wiley & Sons, Ltd., vol. 10(4), pages 341-350, June.
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  26. Carine Milcent & Dormont Brigitte, 2000. "Prospective payment system and costs of hospital stays [Coûts hospitaliers et tarification par pathologie - Le cas de l'infarctus du myocarde aigu]," Post-Print halshs-01990635, HAL.
  27. Wagstaff, Adam & Culyer, Anthony J., 2012. "Four decades of health economics through a bibliometric lens," Journal of Health Economics, Elsevier, vol. 31(2), pages 406-439.
  28. Mario Jametti & Thomas von Ungern-Sternberg, 2006. "Risk Selection in Natural Disaster Insurance – the Case of France," CESifo Working Paper Series 1683, CESifo.
  29. Howell, Bronwyn, 2006. "Paying for the Hospital Waiting List Cull at the GP's Surgery: The Changing Locus of Financial Risk-Bearing in New Zealand's Primary Healthcare Sector," Working Paper Series 3842, Victoria University of Wellington, The New Zealand Institute for the Study of Competition and Regulation.
  30. Richard C. van Kleef & René C. J. A. van Vliet, 2022. "How to deal with persistently low/high spenders in health plan payment systems?," Health Economics, John Wiley & Sons, Ltd., vol. 31(5), pages 784-805, May.
  31. Normann Lorenz, 2013. "Adverse selection and risk adjustment under imperfect competition," Research Papers in Economics 2013-05, University of Trier, Department of Economics.
  32. Mark McClellan, 2000. "Medicare Reform: Fundamental Problems, Incremental Steps," Journal of Economic Perspectives, American Economic Association, vol. 14(2), pages 21-44, Spring.
  33. Laurence Baker & M. Kate Bundorf & Aileen Devlin & Daniel P. Kessler, 2019. "Why Don't Commercial Health Plans Use Prospective Payment?," American Journal of Health Economics, MIT Press, vol. 5(4), pages 465-480, Fall.
  34. Joseph J. Doyle, Jr. & Steven M. Ewer & Todd H. Wagner, 2008. "Returns to Physician Human Capital: Analyzing Patients Randomized to Physician Teams," NBER Working Papers 14174, National Bureau of Economic Research, Inc.
  35. Biorn, Erik & Hagen, Terje P. & Iversen, Tor & Magnussen, Jon, 2002. "The Effect of Activity-Based Financing on Hospital Efficiency: A Panel Data Analysis of DEA Efficiency Scores 1992-2000," MPRA Paper 8099, University Library of Munich, Germany.
  36. Rutten, Frans & Bleichrodt, Han & Brouwer, Werner & Koopmanschap, Marc & Schut, Erik, 2001. "Handbook of Health Economics," Journal of Health Economics, Elsevier, vol. 20(5), pages 855-879, September.
  37. Wang, Jian & Iversen, Tor & Hennig-Schmidt, Heike & Godager, Geir, 2017. "How Changes in Payment Schemes Influence Provision Behavior," HERO Online Working Paper Series 2017:2, University of Oslo, Health Economics Research Programme.
  38. Philippe Widmer, 2015. "Does prospective payment increase hospital (in)efficiency? Evidence from the Swiss hospital sector," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(4), pages 407-419, May.
  39. Trong-Ha Nguyen & Suiwah Leung, 2010. "Dynamics of health insurance ownership in Vietnam, 2004 – 06," CEPR Discussion Papers 643, Centre for Economic Policy Research, Research School of Economics, Australian National University.
  40. Rosella Levaggi, 2007. "Regulating internal markets for hospital care," Journal of Regulatory Economics, Springer, vol. 32(2), pages 173-193, October.
  41. David Crainich & Hervé Leleu & Ana Mauleon, 2008. "The optimality of hospital financing system: the role of physician–manager interactions," International Journal of Health Economics and Management, Springer, vol. 8(4), pages 245-256, December.
  42. Pierre-Yves Geoffard, 2012. "Incentive and Selection Effects in Health Insurance," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 10, Edward Elgar Publishing.
  43. Ana, MAULEON & Laurent, COUDEVILLE & Benoit, DERVAUX, 2004. "Prospective payment system : consequences for hospital-physician interactions in the private sector," LIDAM Discussion Papers IRES 2004011, Université catholique de Louvain, Institut de Recherches Economiques et Sociales (IRES).
  44. Sherry Glied, 2003. "Health Care Costs: On the Rise Again," Journal of Economic Perspectives, American Economic Association, vol. 17(2), pages 125-148, Spring.
  45. Antonio J. Trujillo, 2003. "Medical care use and selection in a social health insurance with an equalization fund: evidence from Colombia," Health Economics, John Wiley & Sons, Ltd., vol. 12(3), pages 231-246, March.
  46. Cutler, David M. & Zeckhauser, Richard J., 2000. "The anatomy of health insurance," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 11, pages 563-643, Elsevier.
  47. David M. Cutler & Sarah Reber, 1996. "Paying for Health Insurance: The Tradeoff between Competition and Adverse Selection," NBER Working Papers 5796, National Bureau of Economic Research, Inc.
  48. Dumont, Etienne & Fortin, Bernard & Jacquemet, Nicolas & Shearer, Bruce, 2008. "Physicians' multitasking and incentives: Empirical evidence from a natural experiment," Journal of Health Economics, Elsevier, vol. 27(6), pages 1436-1450, December.
  49. Brigitte Dormont & Carine Milcent, 2005. "How to Regulate Heterogeneous Hospitals?," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 14(3), pages 591-621, September.
  50. Olivella, Pau & Vera-Hernandez, Marcos, 2007. "Competition among differentiated health plans under adverse selection," Journal of Health Economics, Elsevier, vol. 26(2), pages 233-250, March.
  51. Gaynor, Martin & Vogt, William B., 2000. "Antitrust and competition in health care markets," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 27, pages 1405-1487, Elsevier.
  52. Cogan, John F. & Hubbard, R. Glenn & Kessler, Daniel P., 2010. "The effect of Medicare coverage for the disabled on the market for private insurance," Journal of Health Economics, Elsevier, vol. 29(3), pages 418-425, May.
  53. David Crainich & Hervé Leleu & Ana Mauleon, 2011. "Hospital’s activity-based financing system and manager: physician interaction," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(5), pages 417-427, October.
  54. Diwas S. Kc & Christian Terwiesch, 2009. "Impact of Workload on Service Time and Patient Safety: An Econometric Analysis of Hospital Operations," Management Science, INFORMS, vol. 55(9), pages 1486-1498, September.
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  56. Jacob Glazer & Thomas G. McGuire, 2012. "Optimal Risk Adjustment," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 27, Edward Elgar Publishing.
  57. Lurås, Hilde, 2009. "General Practice: Four Empirical Essays on GP Behaviour and Individuals’ Preferences for GPs," HERO Online Working Paper Series 2004:1, University of Oslo, Health Economics Research Programme.
  58. Mathias Kifmann & Normann Lorenz, 2011. "Optimal cost reimbursement of health insurers to reduce risk selection," Health Economics, John Wiley & Sons, Ltd., vol. 20(5), pages 532-552, May.
  59. Joseph P. Newhouse & Mary Price & John Hsu & J. Michael McWilliams & Thomas G. McGuire, 2015. "How Much Favorable Selection Is Left in Medicare Advantage?," American Journal of Health Economics, University of Chicago Press, vol. 1(1), pages 1-26, Winter.
  60. Ronald Eduardo Gómez Suárez, 2007. "Cream-Skimming And Risk Adjustment in Colombian Health Insurance System:: The Public Insurer Case," Archivos de Economía 4295, Departamento Nacional de Planeación.
  61. Peter Paul Klein & Richard van Kleef & Josefa Henriquez & Francesco Paolucci, 2023. "The interplay between risk adjustment and risk rating in voluntary health insurance," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 90(1), pages 59-91, March.
  62. Pablo Picasso, 2000. "Capitation," Macroeconomics 0004064, University Library of Munich, Germany, revised 24 Feb 2002.
  63. Michel Mougeot & Florence Naegelen, 1997. "La réglementation hospitalière : tarification par pathologie ou achat de soins ?," Économie et Prévision, Programme National Persée, vol. 129(3), pages 207-220.
  64. van de Ven, Wynand P.M.M. & Beck, Konstantin & Van de Voorde, Carine & Wasem, Jurgen & Zmora, Irit, 2007. "Risk adjustment and risk selection in Europe: 6 years later," Health Policy, Elsevier, vol. 83(2-3), pages 162-179, October.
  65. Rudy Douven, 2004. "Risk adjustment in the Netherlands; an analysis of insurers' health care expenditures," CPB Discussion Paper 39.rdf, CPB Netherlands Bureau for Economic Policy Analysis.
  66. Mario Jametti & Thomas von Ungern-Sternberg, 2010. "Risk Selection in Natural-Disaster Insurance," Journal of Institutional and Theoretical Economics (JITE), Mohr Siebeck, Tübingen, vol. 166(2), pages 344-364, June.
  67. Iversen, Tor & Luras, Hilde, 2000. "Economic motives and professional norms: the case of general medical practice," Journal of Economic Behavior & Organization, Elsevier, vol. 43(4), pages 447-470, December.
  68. Howell, Bronwyn, 2007. "Financial Risk in Primary Health Care Contracting: Implications for Sector Structure, Ownership and Outcomes," Working Paper Series 3964, Victoria University of Wellington, The New Zealand Institute for the Study of Competition and Regulation.
  69. M. Kate Bundorf & Jonathan Levin & Neale Mahoney, 2012. "Pricing and Welfare in Health Plan Choice," American Economic Review, American Economic Association, vol. 102(7), pages 3214-3248, December.
  70. Prashant C. Fuloria & Stefanos A. Zenios, 2001. "Outcomes-Adjusted Reimbursement in a Health-Care Delivery System," Management Science, INFORMS, vol. 47(6), pages 735-751, June.
  71. Mark McClellan, 1997. "Hospital Reimbursement Incentives: An Empirical Analysis," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 6(1), pages 91-128, March.
  72. Wang, Jian & Iversen, Tor & Hennig-Schmidt, Heike & Godager, Geir, 2020. "Are patient-regarding preferences stable? Evidence from a laboratory experiment with physicians and medical students from different countries," European Economic Review, Elsevier, vol. 125(C).
  73. Folmer, Cees & Westerhout, Ed, 2008. "Financing medical specialist services in The Netherlands: Welfare implications of imperfect agency," Economic Modelling, Elsevier, vol. 25(5), pages 946-958, September.
  74. Karen Eggleston, 2001. "Multitasking, Competition and Provider Payment," Discussion Papers Series, Department of Economics, Tufts University 0101, Department of Economics, Tufts University.
  75. Mwabu, Germano, 2007. "Health Economics for Low-Income Countries," Center Discussion Papers 10118, Yale University, Economic Growth Center.
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  77. Ching‐To Albert Ma & Michael H. Riordan, 2002. "Health Insurance, Moral Hazard, and Managed Care," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 11(1), pages 81-107, March.
  78. Nazmi Sari, 2002. "Do competition and managed care improve quality?," Health Economics, John Wiley & Sons, Ltd., vol. 11(7), pages 571-584, October.
  79. Anell, Anders & Dackehag, Margareta & Dietrichson, Jens & Ellegård, Lina Maria & Kjellsson, Gustav, 2022. "Better Off by Risk Adjustment? Socioeconomic Disparities in Care Utilization in Sweden Following a Payment Reform," Working Papers 2022:15, Lund University, Department of Economics, revised 12 Mar 2024.
  80. Elizabeth Dhuey & Stephen Lipscomb, 2013. "Funding Special Education by Total District Enrollment: Advantages, Disadvantages, and Policy Considerations," Education Finance and Policy, MIT Press, vol. 8(3), pages 316-331, July.
  81. Liran Einav & Amy Finkelstein, 2018. "Moral Hazard in Health Insurance: What We Know and How We Know It," Journal of the European Economic Association, European Economic Association, vol. 16(4), pages 957-982.
  82. Rajiv L. Sharma, 1998. "Health‐Care Payment Systems: Cost and Quality Incentives—Comment," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 7(1), pages 127-137, March.
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  84. Gemmo, Irina & Kubitza, Christian & Rothschild, Casey G., 2018. "The existence of the Miyazaki-Wilson-Spence equilibrium with continuous type distributions," ICIR Working Paper Series 32/18, Goethe University Frankfurt, International Center for Insurance Regulation (ICIR).
  85. Howell, Bronwyn, 2007. "Financial Risk in Primary Health Care Contracting: Implications for Sector Structure, Ownership and Outcomes," Working Paper Series 19063, Victoria University of Wellington, The New Zealand Institute for the Study of Competition and Regulation.
  86. Hennig-Schmidt, Heike & Selten, Reinhard & Wiesen, Daniel, 2011. "How payment systems affect physicians' provision behaviour--An experimental investigation," Journal of Health Economics, Elsevier, vol. 30(4), pages 637-646, July.
  87. Kyoungrae Jung, 2010. "Incentives for Voluntary Disclosure of Quality Information in HMO Markets," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 77(1), pages 183-210, March.
  88. Roger Feldman & Carlos Escribano & Laura Pellisé, 1998. "The role of government in health insurance markets with adverse selection," Health Economics, John Wiley & Sons, Ltd., vol. 7(8), pages 659-670, December.
  89. Willington Manuel & Alegría Alexander, 2012. "Collusion in a One-Period Insurance Market with Adverse Selection," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 12(1), pages 1-32, April.
  90. Michel Oskam & Richard C. van Kleef & René C. J. A. van Vliet, 2023. "Improving diagnosis-based cost groups in the Dutch risk equalization model: the effects of a new clustering method and allowing for multimorbidity," International Journal of Health Economics and Management, Springer, vol. 23(2), pages 303-324, June.
  91. Kjeld Møller Pedersen & Terkel Christiansen & Mickael Bech, 2005. "The Danish health care system: evolution ‐ not revolution ‐ in a decentralized system," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 41-57, September.
  92. Lawrence Pellegrini & Rosa Rodriguez-Monguio & Jing Qian, 2014. "The US healthcare workforce and the labor market effect on healthcare spending and health outcomes," International Journal of Health Economics and Management, Springer, vol. 14(2), pages 127-141, June.
  93. Henri de Groot & Peter Mulder, 2011. "Energy-intensity developments for 19 OECD countries and 51 sectors," CPB Discussion Paper 171.rdf, CPB Netherlands Bureau for Economic Policy Analysis.
  94. Stefan Felder, 2006. "Risk Adjustment Schemes in Social Health Insurance: Adjusting for Cost Differences Between Insurance Plans," FinanzArchiv: Public Finance Analysis, Mohr Siebeck, Tübingen, vol. 61(4), pages 500-515, February.
  95. Martin Gaynor & Deborah Haas-Wilson, 1999. "Change, Consolidation, and Competition in Health Care Markets," Journal of Economic Perspectives, American Economic Association, vol. 13(1), pages 141-164, Winter.
  96. van de Ven, Wynand P. M. M. & Beck, Konstantin & Buchner, Florian & Chernichovsky, Dov & Gardiol, Lucien & Holly, Alberto & Lamers, Leida M. & Schokkaert, Erik & Shmueli, Amir & Spycher, Stephan & Van, 2003. "Risk adjustment and risk selection on the sickness fund insurance market in five European countries," Health Policy, Elsevier, vol. 65(1), pages 75-98, July.
  97. Gemmo, Irina & Kubitza, Christian & Rothschild, Casey, 2020. "Constrained efficient equilibria in selection markets with continuous types," Journal of Public Economics, Elsevier, vol. 190(C).
  98. Daniel Montanera & Abhay Nath Mishra & T. S. Raghu, 2022. "Mitigating Risk Selection in Healthcare Entitlement Programs: A Beneficiary-Level Competitive Bidding Approach," Information Systems Research, INFORMS, vol. 33(4), pages 1221-1247, December.
  99. Lindrooth, Richard C. & Weisbrod, Burton A., 2007. "Do religious nonprofit and for-profit organizations respond differently to financial incentives? The hospice industry," Journal of Health Economics, Elsevier, vol. 26(2), pages 342-357, March.
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  116. Randall P. Ellis & Juan Gabriel Fernandez, 2013. "Risk Selection, Risk Adjustment and Choice: Concepts and Lessons from the Americas," IJERPH, MDPI, vol. 10(11), pages 1-34, October.
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  124. Bourgeon, Jean-Marc & Picard, Pierre & Pouyet, Jerome, 2008. "Providers' affiliation, insurance and collusion," Journal of Banking & Finance, Elsevier, vol. 32(1), pages 170-186, January.
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  128. Ma, Ching-to Albert & Mak, Henry Y., 2015. "Information disclosure and the equivalence of prospective payment and cost reimbursement," Journal of Economic Behavior & Organization, Elsevier, vol. 117(C), pages 439-452.
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  130. Bardey, David & Canta, Chiara & Lozachmeur, Jean-Marie, 2010. "Health Care Providers Payments Regulation when Horizontal and Vertical Differentiation Matter," TSE Working Papers 10-164, Toulouse School of Economics (TSE).
  131. Brigitte Dormont & Carine Milcent, 2004. "The sources of hospital cost variability," Health Economics, John Wiley & Sons, Ltd., vol. 13(10), pages 927-939, October.
  132. Davidoff, Amy & Blumberg, Linda & Nichols, Len, 2005. "State health insurance market reforms and access to insurance for high-risk employees," Journal of Health Economics, Elsevier, vol. 24(4), pages 725-750, July.
  133. Nolan Miller & Karen Eggleston & Richard Zeckhauser, 2006. "Provider choice of quality and surplus," International Journal of Health Economics and Management, Springer, vol. 6(2), pages 103-117, June.
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