Four Essays on Technological and Organizational Change in Health Care

This thesis contains four essays on technological and organizational change in health care. Although each chapter can be read independently, there is a central thread resumed in each chapter. The interaction of patient, physician and insurer in the health care market is analysed in different contexts. Chapter 2 studies the physician's decision to adopt new technologies in a situation where patients have control over the amount of health care consumed. This setup of ex-post moral hazard is complemented in chapter 3 by an analysis of supplier-induced demand. Providers' technology choice and adoption of innovations here depend on the profitability of treatment and patients' willingness to consent. A conclusion which may be drawn from these sections is a call for a more integrated provision of health care in the form of managed care. Chapter 4 contains an analysis which explains why physicians, particularly in Germany, are often very much opposed to such new organizational forms of provision of care. In chapter 5, it is shown that patients may not always want to make use of the opportunities offered by technological progress. Information on one's health status which may be acquired, for instance, by genetic tests, may be declined by individuals who fear a breakdown of will. This finding has important implications for the disclosure of information by physicians and for the information acquisition policy of insurers.