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Policy Analysis in the Health-Services Market: Accounting for Quality and Quantity

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  • Bernard Fortin
  • Nicolas Jacquemet
  • Bruce Shearer

Abstract

We provide a theoretical and empirical framework for evaluating the effects of policy reforms on physician labor supply. We argue that any policy evaluation must account for both the quality and the quantity of services provided. The introduction of quality into the analysis has implications for both the theoretical and empirical analysis of labor supply, and consequently policy evaluation. In particular, endogenous quality choices introduce non-linearities into the budget constraint since the marginal return to an hour of work depends on the quality of services provided. We illustrate by considering a particular example: the recent reform in compensation contracts for specialist physicians in the province of Quebec (Canada). Prior to 1999, most Quebec specialist physicians were paid fee-for-service contracts; they received a piece rate for each clinical service provided. In 1999, the government introduced a mixed remuneration system, under which physicians received a base (half-daily or daily) wage, independent of services provided, and a reduced fee-for-service. Moreover, the government allowed physicians to choose their contract. We derive theoretical results for the effect of the reform on the quantity and quality of services supplied by analyzing "local" prices and virtual income. We propose discretizing the choice set as an empirical approach to policy evaluation in the presence of non-linear budget constraints.

Suggested Citation

  • Bernard Fortin & Nicolas Jacquemet & Bruce Shearer, 2008. "Policy Analysis in the Health-Services Market: Accounting for Quality and Quantity," Cahiers de recherche 0807, CIRPEE.
  • Handle: RePEc:lvl:lacicr:0807
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    Cited by:

    1. Rudoler, David & Laporte, Audrey & Barnsley, Janet & Glazier, Richard H. & Deber, Raisa B., 2015. "Paying for primary care: A cross-sectional analysis of cost and morbidity distributions across primary care payment models in Ontario Canada," Social Science & Medicine, Elsevier, vol. 124(C), pages 18-28.
    2. Weeks, William B. & Paraponaris, Alain & Ventelou, Bruno, 2013. "Sex-based differences in income and response to proposed financial incentives among general practitioners in France," Health Policy, Elsevier, vol. 113(1), pages 199-205.
    3. Fortin, Bernard & Jacquemet, Nicolas & Shearer, Bruce, 2010. "Labour Supply, Work Effort and Contract Choice: Theory and Evidence on Physicians," CLSSRN working papers clsrn_admin-2010-30, Vancouver School of Economics, revised 21 Oct 2010.
    4. Etienne Dumont & Bernard Fortin & Nicolas Jacquemet & Bruce Shearer, 2011. "Rémunération mixte et comportement professionnel des spécialistes," PSE-Ecole d'économie de Paris (Postprint) halshs-01114074, HAL.
    5. Dumont, Etienne & Fortin, Bernard & Jacquemet, Nicolas & Shearer, Bruce, 2008. "Physicians' multitasking and incentives: Empirical evidence from a natural experiment," Journal of Health Economics, Elsevier, vol. 27(6), pages 1436-1450, December.
    6. Marie Allard & Izabela Jelovac & Pierre-Thomas Léger, 2010. "Physicians self selection of a payment mechanism: Capitation versus fee-for-service," Working Papers 1024, Groupe d'Analyse et de Théorie Economique Lyon St-Étienne (GATE Lyon St-Étienne), Université de Lyon.
    7. Marie Allard & Izabela Jelovac & Pierre-Thomas Léger, 2014. "Payment mechanism and GP self-selection: capitation versus fee for service," International Journal of Health Economics and Management, Springer, vol. 14(2), pages 143-160, June.
    8. David Bardey & Helmuth Cremer & Jean-Marie Lozachmeur, 2011. "Doctors´ remuneration schemes and hospital competition in two-sided markets with common network externalities," Documentos de Trabajo 008848, Universidad del Rosario.
    9. David Bardey & Helmuth Cremer & Jean-Marie Lozachmeur, 2014. "Competition in Two-Sided Markets with Common Network Externalities," Review of Industrial Organization, Springer;The Industrial Organization Society, vol. 44(4), pages 327-345, June.
    10. Bardey, David & Cremer, Helmuth & Lozachmeur, Jean-Marie, 2011. "Doctors' remuneration schemes and hospital competition in two-sided markets with common network externalities," TSE Working Papers 11-250, Toulouse School of Economics (TSE), revised Jul 2011.
    11. Bernard Fortin & Nicolas Jacquemet & Bruce Shearer, 2019. "Labour Supply, Service Intensity and Contract Choice: Theory and Evidence on Physicians," Université Paris1 Panthéon-Sorbonne (Post-Print and Working Papers) halshs-02158484, HAL.

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    More about this item

    Keywords

    Health production; Quality of health services; Discretized models;
    All these keywords.

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • D11 - Microeconomics - - Household Behavior - - - Consumer Economics: Theory
    • C25 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Discrete Regression and Qualitative Choice Models; Discrete Regressors; Proportions; Probabilities

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