Information asymmetry, insurance, and the decision to hospitalize
In a theoretical model, we analyze the effects of various kinds of demand- and supply-side incentives in the context of a model in which patients and doctors must decide not only on an aggregate quantity of health services to use in treating various kinds of illness, but also have a choice between different kinds of providers (in particular, outpatient services rendered by primary-care physicians or inpatient services provided by hospital-based specialists). We present two broad models, the traditional fee-for-service payment scheme and a managed care setup where physicians are paid via capitation, and analyze them both with and without information asymmetry. We find that under certain plausible conditions, second-best optimal managed care plans may dominate second-best optimal conventional plans that rely on cost control through demand-side cost sharing. À l'aide d'un modèle théorique dans lequel patients et médecins doivent choisir la quantité de service à utiliser ainsi que celui, de l'omnipraticien ou du spécialiste uvrant à l'hôpital, qui fournira ces services, nous analysons différents mécanismes d'incitation agissant sur l'offre et la demande. Nous étudions essentiellement deux modes d'organisation : le système conventionnel de rémunération à l'acte et le système de gestion intégrée des soins avec une rémunération per capita; à la fois en présence et en l'absence d'asymétrie d'information. Nous obtenons comme résultat qu'à certaines conditions plausibles, l'optimum de second-rang auquel mène le système de gestion intégrée est supérieur à celui que donne le système conventionnel de rémunération à l'acte qui répercute une partie des coûts sur l'utilisateur.
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- Rochaix, Lise, 1989. "Information asymmetry and search in the market for physicians' services," Journal of Health Economics, Elsevier, vol. 8(1), pages 53-84, March.
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- Gravelle, Hugh & Dusheiko, Mark & Sutton, Matthew, 2002. "The demand for elective surgery in a public system: time and money prices in the UK National Health Service," Journal of Health Economics, Elsevier, vol. 21(3), pages 423-449, May.
- Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-77, June.
- Pierre Thomas Léger, 2000. "Quality control mechanisms under capitation payment for medical services," Canadian Journal of Economics, Canadian Economics Association, vol. 33(2), pages 564-586, May.
- Glied, Sherry, 2000. "Managed care," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 13, pages 707-753 Elsevier.
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