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Health Service Gatekeepers

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  • James Malcomson

Abstract

Incentive contracts for gatekeepers who control patient access to specialist medical services provide too weak incentives to investigate cost further when expected cost of treatment is greater than benefit. Making gatekeepers residual claimants with a fixed fee from which treat-ment costs must be met (as with full insurers who are themselves gatekeepers) provides too strong incentives when expected cost is less than benefit. Giving patients the choice between a gatekeeper with an incentive contract and one without is unstable. With one scenario, pa- tients always prefer the latter. With another, patients have incentives to acquire information that makes incentive contracts ineffective.

Suggested Citation

  • James Malcomson, 2003. "Health Service Gatekeepers," CESifo Working Paper Series 1063, CESifo Group Munich.
  • Handle: RePEc:ces:ceswps:_1063
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    File URL: http://www.cesifo-group.de/DocDL/cesifo1_wp1063.pdf
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    References listed on IDEAS

    as
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    More about this item

    Keywords

    gatekeepers; patient referrals; general practitioners; fundholding; medical insurance; incentive contracts;

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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