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Reforming incentive schemes under political constraints: The physician agency

  • Gabrielle Demange

    (PSE - Paris-Jourdan Sciences Economiques - CNRS : UMR8545 - Ecole des Hautes Etudes en Sciences Sociales (EHESS) - Ecole des Ponts ParisTech - Ecole Normale Supérieure de Paris - ENS Paris)

  • Pierre Yves Geoffard

    (PSE - Paris-Jourdan Sciences Economiques - CNRS : UMR8545 - Ecole des Hautes Etudes en Sciences Sociales (EHESS) - Ecole des Ponts ParisTech - Ecole Normale Supérieure de Paris - ENS Paris)

In many developed countries attempts to reform physicians payment schemes have failed. To analyze some of the difficulties, this paper studies reforms of payment schemes in situations such as the physician agency, where the quality of the good produced is imperfectly observable by the payer. We first study the situation, common in many countries, where physicians face a single scheme. We identify conditions under which no reform can both obtain the consent of a large proportion of physicians (political constraints) and improve patients welfare. We then study whether a menu of contracts, with or without cross subsidies, may solve the difficulties generated by the heterogeneity of producers practice. /// Dans de nombreux pays, les réformes visant à modifier les modes de rémunération des prescripteurs de soins se sont heurtées à leur forte opposition. Ce papier analyse ces difficultés, d'abord dans un cadre de monopole puis de concurrence régulée entre différentes organisations. Quelques facteurs clefs sont mis en évidence: ils sont liés au pouvoir politique des médecins, à l'hétérogénéité de leurs caractéristiques et de leurs comportements.

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Paper provided by HAL in its series Post-Print with number halshs-00581377.

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Date of creation: 2006
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Publication status: Published, Annales d'économie et de statistique, 2006, 221-250
Handle: RePEc:hal:journl:halshs-00581377
Note: View the original document on HAL open archive server: http://halshs.archives-ouvertes.fr/halshs-00581377
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  1. Ma, Ching-to Albert & McGuire, Thomas G, 1997. "Optimal Health Insurance and Provider Payment," American Economic Review, American Economic Association, vol. 87(4), pages 685-704, September.
  2. Holly, Alberto & Gardiol, Lucien & Domenighetti, Gianfranco & Brigitte Bisig, 1998. "An econometric model of health care utilization and health insurance in Switzerland," European Economic Review, Elsevier, vol. 42(3-5), pages 513-522, May.
  3. McGuire, Thomas G., 2000. "Physician agency," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 9, pages 461-536 Elsevier.
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