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Health Service Gatekeepers

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  • James Malcomson

Abstract

Incentive contracts for gatekeepers who control patient access to specialist medical services provide too weak incentives to investigate cost further when expected cost of treatment is greater than benefit. Making gatekeepers residual claimants with a fixed fee from which treatment costs must be met (as with full insurers who are themselves gatekeepers) provides too strong incentives when expected cost is less than benefit. Giving patients the choice between a gatekeeper with an incentive contract and one without is unstable. With one scenario, patients always prefer the latter. With another, patients have incentives to acquire information that makes incentive contracts ineffective.

Suggested Citation

  • James Malcomson, 2003. "Health Service Gatekeepers," Economics Series Working Papers 169, University of Oxford, Department of Economics.
  • Handle: RePEc:oxf:wpaper:169
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    File URL: http://www.economics.ox.ac.uk/materials/working_papers/paper169.pdf
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    References listed on IDEAS

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    Citations

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    Cited by:

    1. Dolton, Peter & Pathania, Vikram, 2016. "Can increased primary care access reduce demand for emergency care? Evidence from England's 7-day GP opening," Journal of Health Economics, Elsevier, vol. 49(C), pages 193-208.
    2. Tor Iversen & Ching-to Ma, 2011. "Market conditions and general practitioners’ referrals," International Journal of Health Economics and Management, Springer, vol. 11(4), pages 245-265, December.
    3. Tugba Büyükdurmus & Thomas Kopetsch & Hendrik Schmitz & Harald Tauchmann, 2017. "On the interdependence of ambulatory and hospital care in the German health system," Health Economics Review, Springer, vol. 7(1), pages 1-19, December.
    4. 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, pages 143-160.
    5. Felder, Stefan & Amann, Erwin, 2017. "No Crowding Out despite Kickbacks: Competition between Gatekeeping GPs," Annual Conference 2017 (Vienna): Alternative Structures for Money and Banking 168116, Verein für Socialpolitik / German Economic Association.
    6. Jodi L. Short & Michael W. Toffel & Andrea Read Hugill, 2013. "Monitoring Global Supply Chains," Harvard Business School Working Papers 14-032, Harvard Business School, revised Jun 2015.
    7. Martin Chalkley, 2012. "Contracts, Information and Incentives in Health Care," Chapters,in: The Elgar Companion to Health Economics, Second Edition, chapter 22 Edward Elgar Publishing.
    8. Shinya Sugawara & Jiro Nakamura, 2014. "Incentive for Gatekeepers and Their Demand Inducement: An Empirical Analysis of Care Managers in the Japanese Long-Term Care Insurance," CIRJE F-Series CIRJE-F-916, CIRJE, Faculty of Economics, University of Tokyo.
    9. Martin Chalkley, 2012. "Contracts, Information and Incentives in Health Care," Chapters,in: The Elgar Companion to Health Economics, Second Edition, chapter 22 Edward Elgar Publishing.
    10. Hsiao-Hui Lee & Edieal J. Pinker & Robert A. Shumsky, 2012. "Outsourcing a Two-Level Service Process," Management Science, INFORMS, pages 1569-1584.

    More about this item

    Keywords

    Gatekeepers; Patient refererrals; General practitioners; Fundholding; Medical insurance; Incentive contracts.;

    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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