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Public and Private Health Care Financing with Alternate Public Rationing Rules

Author

Listed:
  • Katherine Cuff

    () (Department of Economics, McMaster University)

  • Jeremiah Hurley

    (Department of Economics and Department of Clinical Epidemiology and Biostatistics, McMaster University)

  • Stuart Mestelman
  • Andrew Muller

    (Department of Economics, McMaster University)

  • Robert Nuscheler

    (Department of Economics, University of Waterloo)

Abstract

We develop a model to analyze alternative health care financing arrangements. Health care is demanded by individuals varying in income and severity of illness. There is a limited supply of health care resources used to treat individuals, causing some individuals to go untreated. We examine outcomes under full public finance, full private finance, and mixed, parallel public and private finance under two rationing rules for the public sector: needs-based rationing and random rationing. Insurers (both public and private) must bid to obtain the necessary health care resources to treat their beneficiaries. While public insurer's ability-to-pay is limited by its (fixed) budget; the private insurers willingness-to-pay reflects the individuals' willingness-to-pay for care. When permitted, the private sector supplies supplementary health care to those willing and able to pay. We find that the introduction of a private sector diverts treatment from relatively poor to relatively rich individuals. Moreover, if the public system allocates care according to need, then the average severity of the untreated is higher in a mixed system than in a pure public system. While we can unambiguously sign most comparative static effects for a general set of distribution functions, an analysis of the relationship between public sector rationing and the scope for a private health insurance market requires distributional assumptions. For a bivariate uniform distribution function we find that the private health insurance market is smaller when the public sector rations according to need as compared to random allocation of health care.

Suggested Citation

  • Katherine Cuff & Jeremiah Hurley & Stuart Mestelman & Andrew Muller & Robert Nuscheler, 2007. "Public and Private Health Care Financing with Alternate Public Rationing Rules," Centre for Health Economics and Policy Analysis Working Paper Series 2007-07, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
  • Handle: RePEc:hpa:wpaper:200707
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    Cited by:

    1. Daniele Fabbri & Chiara Monfardini, 2016. "Opt Out or Top Up? Voluntary Health Care Insurance and the Public vs. Private Substitution," Oxford Bulletin of Economics and Statistics, Department of Economics, University of Oxford, vol. 78(1), pages 75-93, February.
    2. Buckley, Neil J. & Cuff, Katherine & Hurley, Jeremiah & McLeod, Logan & Mestelman, Stuart & Cameron, David, 2012. "An experimental investigation of mixed systems of public and private health care finance," Journal of Economic Behavior & Organization, Elsevier, vol. 84(3), pages 713-729.
    3. Kuhn, Michael & Nuscheler, Robert, 2013. "Saving the public from the private? Incentives and outcomes in dual practice," ECON WPS - Vienna University of Technology Working Papers in Economic Theory and Policy 02/2013, Vienna University of Technology, Institute for Mathematical Methods in Economics, Research Group Economics (ECON).
    4. repec:kap:ijhcfe:v:17:y:2017:i:2:d:10.1007_s10754-016-9209-1 is not listed on IDEAS
    5. Laura Levaggi & Rosella Levaggi, 2016. "Welfare analysis of rationing in health care provision," Working papers 39, Società Italiana di Economia Pubblica.
    6. Mario Menegatti, 2014. "Optimal choice on prevention and cure: a new economic analysis," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(4), pages 363-372, May.

    More about this item

    Keywords

    health care financing; rationing rules;

    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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