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Yardstick Competition when Quality is Endogenous: The Case of Hospital Regulation

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  • Hanjo M. Koehler

Abstract

In many countries hospital regulation undergoes fundamental change. In reaction to steadily increasing costs, authorities switch from cost of service regulation to prospective payment systems (PPS). While it seems clear that this new scheme sets strong cost saving incentives, this is not so clear for quality provision. As a matter of fact, everything hinges on the prices the regulator sets. Figuring out optimal prices is, however, a difficult task, be- cause the regulator faces serious informational limitations. The literature largely ignores this problem and points to Shleifer's (1985) yardstick compe- tition for a solution. Yardstick competition, however, ignores quality issues. This paper fills this gap in the literature and shows that endogenizing qual- ity changes the results of yardstick competition substantially. Quality will be zero and cost reduction efforts can be heavily distorted. In general, a simpler version of yardstick competition average cost pricing turns out to be more favorable, though not perfect.

Suggested Citation

  • Hanjo M. Koehler, 2006. "Yardstick Competition when Quality is Endogenous: The Case of Hospital Regulation," Working Papers 013, Bavarian Graduate Program in Economics (BGPE).
  • Handle: RePEc:bav:wpaper:013_koehler
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    File URL: http://www.bgpe.de/texte/DP/013_koehler.pdf
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    References listed on IDEAS

    as
    1. Ma, Ching-to Albert, 1994. "Health Care Payment Systems: Cost and Quality Incentives," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 3(1), pages 93-112, Spring.
    2. Newhouse, Joseph P. & Byrne, Daniel J., 1988. "Did Medicare's Prospective Payment System cause length of stay to fall?," Journal of Health Economics, Elsevier, vol. 7(4), pages 413-416, December.
    3. Andrei Shleifer, 1985. "A Theory of Yardstick Competition," RAND Journal of Economics, The RAND Corporation, vol. 16(3), pages 319-327, Autumn.
    4. Richard G. Frank & Judith R. Lave, 1989. "A Comparison of Hospital Responses to Reimbursement Policies for Medicaid Psychiatric Patients," RAND Journal of Economics, The RAND Corporation, vol. 20(4), pages 588-600, Winter.
    5. Ellis, Randall P. & McGuire, Thomas G., 1996. "Hospital response to prospective payment: Moral hazard, selection, and practice-style effects," Journal of Health Economics, Elsevier, vol. 15(3), pages 257-277, June.
    6. Ellis, Randall P. & McGuire, Thomas G., 1986. "Provider behavior under prospective reimbursement : Cost sharing and supply," Journal of Health Economics, Elsevier, vol. 5(2), pages 129-151, June.
    7. David Dranove, 1987. "Rate-Setting by Diagnosis Related Groups and Hospital Specialization," RAND Journal of Economics, The RAND Corporation, vol. 18(3), pages 417-427, Autumn.
    8. Cutler, David M, 1995. "The Incidence of Adverse Medical Outcomes under Prospective Payment," Econometrica, Econometric Society, vol. 63(1), pages 29-50, January.
    9. Pope, Gregory C., 1989. "Hospital nonprice competition and medicare reimbursement policy," Journal of Health Economics, Elsevier, vol. 8(2), pages 147-172, June.
    10. Hodgkin, Dominic & McGuire, Thomas G., 1994. "Payment levels and hospital response to prospective payment," Journal of Health Economics, Elsevier, vol. 13(1), pages 1-29, March.
    Full references (including those not matched with items on IDEAS)

    More about this item

    Keywords

    Yardstick Competition; Regulation; Hospital Market;

    JEL classification:

    • L5 - Industrial Organization - - Regulation and Industrial Policy
    • I1 - Health, Education, and Welfare - - Health
    • D4 - Microeconomics - - Market Structure, Pricing, and Design

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