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Optimal Health Insurance and Provider Payment


  • Ching-to Albert Ma


  • Thomas G. McGuire



The authors derive optimal insurance for patients and payment method for physicians when neither the input decided by the patient (quantity of treatment) nor the input decided by the physician (effort) are contractible. The equilibrium in this third-best regime may sometimes be second best, in which both the physician input and the report of treatment are verifiable. Otherwise, truthful reporting forces a third best, characterized by provider 'prospective payment' and suboptimal effort, while consumers' demand becomes excessive. The authors also analyze how 'professional ethics' alters the equilibrium. Finally, collusive reporting mechanisms imply more stringent constraints, while competition among physicians relaxes them. Copyright 1997 by American Economic Association.
(This abstract was borrowed from another version of this item.)

Suggested Citation

  • Ching-to Albert Ma & Thomas G. McGuire, 1995. "Optimal Health Insurance and Provider Payment," Papers 0059, Boston University - Industry Studies Programme.
  • Handle: RePEc:fth:bostin:0059

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    References listed on IDEAS

    1. Gertler, Paul & Locay, Luis & Sanderson, Warren, 1987. "Are user fees regressive? : The welfare implications of health care financing proposals in Peru," Journal of Econometrics, Elsevier, vol. 36(1-2), pages 67-88.
    2. Heller, Peter S., 1982. "A model of the demand for medical and health services in Peninsular Malaysia," Social Science & Medicine, Elsevier, vol. 16(3), pages 267-284, January.
    3. Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-255, March-Apr.
    4. William H. Dow, 1999. "Flexible Discrete Choice Demand Models Consistent With Utility Maximization: An Application to Health Care Demand," American Journal of Agricultural Economics, Agricultural and Applied Economics Association, vol. 81(3), pages 680-685.
    5. Mwabu, Germano M., 1986. "Health care decisions at the household level: Results of a rural health survey in Kenya," Social Science & Medicine, Elsevier, vol. 22(3), pages 315-319, January.
    6. Florian Heiss, 2002. "Structural choice analysis with nested logit models," Stata Journal, StataCorp LP, vol. 2(3), pages 227-252, August.
    7. Dor, Avi & Gertler, Paul & van der Gaag, Jacques, 1987. "Non-price rationing and the choice of medical care providers in rural Cote d'Ivoire," Journal of Health Economics, Elsevier, vol. 6(4), pages 291-304, December.
    8. Kenneth Train, 1985. "Qualitative Choice Analysis: Theory, Econometrics, and an Application to Automobile Demand," MIT Press Books, The MIT Press, edition 1, volume 1, number 0262200554, January.
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