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Payer Competition and Cost Shifting in Health Care

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  • Glazer, Jacob
  • McGuire, Thomas G

Abstract

This paper studies a model in which two payers contract with one hospital. True costs per patient are not a possible basis for payment, and contracts can only be written on the basis of allocated cost. Payers choose a contract that is fully prospective or fully based on cost allocation, or a payment scheme that would give some weight to each of these two. We characterize the payers' equilibrium contracts and show how in equilibrium hospital input decisions are distorted by the payers' incentives to engage in cost shifting. Two cost-shifting incentives work in opposite directions, and equilibrium can be characterized by too little or too much care relative to the socially efficient level. Copyright 1994 by MIT Press.

Suggested Citation

  • Glazer, Jacob & McGuire, Thomas G, 1994. "Payer Competition and Cost Shifting in Health Care," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 3(1), pages 71-92, Spring.
  • Handle: RePEc:bla:jemstr:v:3:y:1994:i:1:p:71-92
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    Cited by:

    1. Chalkley, Martin & Malcomson, James M., 1998. "Contracting for health services when patient demand does not reflect quality," Journal of Health Economics, Elsevier, vol. 17(1), pages 1-19, January.
    2. Zhou, Huizhong & Tamas, Meszaros Matyas, 2010. "Impacts of integration of production of black and green energy," Energy Economics, Elsevier, vol. 32(1), pages 220-226, January.
    3. Jack, William, 2005. "Purchasing health care services from providers with unknown altruism," Journal of Health Economics, Elsevier, vol. 24(1), pages 73-93, January.
    4. Chalkley, Martin & McVicar, Duncan, 2008. "Choice of contracts in the British National Health Service: An empirical study," Journal of Health Economics, Elsevier, vol. 27(5), pages 1155-1167, September.
    5. Kesteloot, K. & Voet, N., 1998. "Incentives for cooperation in quality improvement among hospitals--the impact of the reimbursement system," Journal of Health Economics, Elsevier, vol. 17(6), pages 701-728, December.
    6. Ellis, Randall P., 1998. "Creaming, skimping and dumping: provider competition on the intensive and extensive margins1," Journal of Health Economics, Elsevier, vol. 17(5), pages 537-555, October.
    7. Bos, Dieter & De Fraja, Gianni, 2002. "Quality and outside capacity in the provision of health services," Journal of Public Economics, Elsevier, vol. 84(2), pages 199-218, May.
    8. Lise Rochaix, 1997. "Asymétries d'information et incertitude en santé : les apports de la théorie des contrats," Économie et Prévision, Programme National Persée, vol. 129(3), pages 11-24.
    9. Vivian Wu, 2010. "Hospital cost shifting revisited: new evidence from the balanced budget act of 1997," International Journal of Health Economics and Management, Springer, vol. 10(1), pages 61-83, March.
    10. Ryuta Ray Kato & Makoto Kakinaka, 2008. "Behavioral Difference between Self-Employed and Hospital-Employed Physicians in Japan," Working Papers EMS_2008_07, Research Institute, International University of Japan.
    11. Makoto Kakinaka & Ryuta Ray Kato, 2008. "Intrinsic Motivation of Physicians," Working Papers EMS_2008_02, Research Institute, International University of Japan.
    12. Martin Chalkley & Duncan McVicar, 2001. "Contracts in the National Health Service: An Empirical Study," Dundee Discussion Papers in Economics 124, Economic Studies, University of Dundee.
    13. Makoto Kakinaka & Ryuta Kato, 2013. "Regulated medical fee schedule of the Japanese health care system," International Journal of Health Economics and Management, Springer, vol. 13(3), pages 301-317, December.
    14. Dan Friesner & Robert Rosenman, 2004. "Non-profit cost-adjusting with quality as a private good," Applied Economics, Taylor & Francis Journals, vol. 36(5), pages 511-523.

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