A comparison between two health care delivery systems using a spatial competition model approach

“…However, different payment systems might provide different incentives for hospitals in terms of healthcare delivery, which would potentially affect the effects of market competition on quality improvement. 36 For example, under the DRGs payment system, the government sets a fee for each diagnosis-related group, regardless of the quality of treatment supplied by the hospitals. As this system is designed for cost containment, hospitals would have an incentive to adopt the most costeffective treatment and have less concern about the quality of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…14 More importantly, payment systems would potentially affect the providers' incentives to compete in the healthcare market. 36 Therefore, our empirical evidence derived from rural China with the fee-for-service payment system was expected to provide implications for other countries with similar settings in healthcare delivery. Second, the Herfindahl-Hirschman Index (HHI) has been commonly used in previous studies to measure hospital competition.…”

Section: Introductionmentioning

confidence: 99%

<p>Perceived Competition and Process of Care in Rural China</p>

Lin

Jian

Yip

et al. 2020

RMHP

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Purpose: Although there is much debate about the effect of hospital competition on healthcare quality, its impact on the process of care remains unclear. This study aimed to determine whether hospital competition improves the process of care in rural China. Patients and Methods: The county hospital questionnaire survey data and the randomly sampled medical records of bacterial pneumonia patients in 2015 in rural area of Guizhou, China, were used in this study. The processes of care for bacterial pneumonia were measured by the following three measures: 1) oxygenation assessment, 2) antibiotic treatment, and 3) first antibiotic treatment within 6 hours after admission. Hospital competition was measured by asking hospital directors to rate the competition pressure they perceive from other hospitals. Multivariate logistic regression models were employed to determine the relationship between perceived competition and the processes of care for patients with bacterial pneumonia. Results: A total of 2167 bacterial pneumonia patients from 24 county hospitals in 2015 were included in our study. Our results suggested that the likelihood of receiving antibiotic treatment and first antibiotic treatment within 6 hours after admission was significantly higher in the hospitals perceiving higher competition pressure. However, no significant relationship was found between perceived competition and oxygenation assessment for patients with bacterial pneumonia. Conclusion: This study revealed the role of perceived competition in improving the process of care under the fee-for-service payment system and provided empirical evidence to support the pro-competition policies in China's new round of national healthcare reform.

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“…However, the current literature lacks studies on the relationship between insurers and practices with regard to capitation and FFS payments. Rather, prior work focuses on the effects of capitation and FFS payment systems on patients [5] rather than a broader segment of the healthcare system.…”

Section: Introductionmentioning

confidence: 99%

“…In response, we model the practice as a party that can set the fraction of patient visits f 2 conducted under an FFS model (i.e., visits without proactive team or nonvisit care). This can be played as a Stackelberg game [5] wherein the first player, the insurer, sets the value of f 1 so that the insurer’s net cost is minimized. In response, the practice sets f 2 so that the practice’s total revenue is maximized.…”

Section: Introductionmentioning

confidence: 99%

A game theoretic setting of capitation versus fee-for-service payment systems

Koenecke

2019

PLoS ONE

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We aim to determine whether a game-theoretic model between an insurer and a healthcare practice yields a predictive equilibrium that incentivizes either player to deviate from a fee-for-service to capitation payment system. Using United States data from various primary care surveys, we find that non-extreme equilibria (i.e., shares of patients, or shares of patient visits, seen under a fee-for-service payment system) can be derived from a Stackelberg game if insurers award a non-linear bonus to practices based on performance. Overall, both insurers and practices can be incentivized to embrace capitation payments somewhat, but potentially at the expense of practice performance.

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A comparison between two health care delivery systems using a spatial competition model approach

Cited by 3 publications

References 15 publications

The role of open access in a changing academy: reflections on a new publishing paradigm

The role of open access in a changing academy: reflections on a new publishing paradigm

<p>Perceived Competition and Process of Care in Rural China</p>

A game theoretic setting of capitation versus fee-for-service payment systems

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