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Sticking Points: Common-Agency Problems and Contracting in the U.S. Healthcare System


  • Brigham Frandsen
  • Michael Powell
  • James B. Rebitzer


We propose a "common-agency" model for explaining inefficient contracting in the U.S. healthcare system. In our setting, common-agency problems arise when multiple payers seek to motivate a shared provider to invest in improved care coordination. Our approach differs from other common-agency models in that we analyze "sticking points," that is, equilibria in which payers coordinate around Pareto-dominated contracts that do not offer providers incentives to implement efficient investments. These sticking points offer a straightforward explanation for three long observed but hard to explain features of the U.S. healthcare system: the ubiquity of fee-for-service contracting arrangements outside of Medicare; problematic care coordination; and the historic reliance on small, single specialty practices rather than larger multi-specialty group practices to deliver care. The common-agency model also provides insights on the effects of policies, such as Accountable Care Organizations, that aim to promote more efficient forms of contracting between payers and providers.

Suggested Citation

  • Brigham Frandsen & Michael Powell & James B. Rebitzer, 2017. "Sticking Points: Common-Agency Problems and Contracting in the U.S. Healthcare System," NBER Working Papers 23177, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:23177
    Note: HC

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    References listed on IDEAS

    1. B. Douglas Bernheim & Michael D. Whinston, 1986. "Menu Auctions, Resource Allocation, and Economic Influence," The Quarterly Journal of Economics, Oxford University Press, vol. 101(1), pages 1-31.
    2. Timothy Besley & Stephen Coate, 2001. "Lobbying and Welfare in a Representative Democracy," Review of Economic Studies, Oxford University Press, vol. 68(1), pages 67-82.
    3. Randall D. Cebul & James B. Rebitzer & Lowell J. Taylor & Mark E. Votruba, 2008. "Organizational Fragmentation and Care Quality in the U.S. Healthcare System," Journal of Economic Perspectives, American Economic Association, vol. 22(4), pages 93-113, Fall.
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    More about this item

    JEL classification:

    • D8 - Microeconomics - - Information, Knowledge, and Uncertainty
    • I10 - Health, Education, and Welfare - - Health - - - General
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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