A model of the impact of reimbursement schemes on health plan choice

Keeler, Emmett B.; Carter, Grace M.; Newhouse, Joseph P.

doi:10.1016/s0167-6296(97)00029-5

Cited by 47 publications

(30 citation statements)

References 13 publications

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“…To represent commonality in our framework we adopt the concept of shadow prices. (See Keeler et al, 1998 andFrank et al, 2000. ) Let q be a shadow price the provider sets determining access to care.…”

Section: The Public Payer: Medicarementioning

confidence: 99%

Multiple payers, commonality and free-riding in health care: Medicare and private payers

Glazer

McGuire

2002

Journal of Health Economics

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Managed health care plans and providers in the US and elsewhere sell their services to multiple payers. For example, the three largest groups of purchasers from health plans in the US are employers, Medicaid plans, and Medicare, with the first two accounting for over 90% of the total enrollees. In the case of hospitals, Medicare is the largest buyer, but it alone only accounts for 40% of the total payments. While payers have different objectives and use different contracting practices, the plans and providers set some elements of the quality in common for all payers. In this paper, we study the interactions between a public payer, modeled on Medicare, which sets a price and takes any willing provider, a private payer, which limits providers and pays a price on the basis of quality, and a provider/plan, in the presence of shared elements of quality. The provider compromises in response to divergent incentives from payers. The private sector dilutes Medicare payment initiatives, and may, under some circumstances, repair Medicare payment policy mistakes. If Medicare behaves strategically in the presence of private payers, it can free-ride on the private payer and set its prices too low. Our paper has many testable implications, including a new hypothesis for why Medicare has failed to gain acceptance of health plans in the US.

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Section: The Public Payer: Medicarementioning

confidence: 99%

Multiple payers, commonality and free-riding in health care: Medicare and private payers

Glazer

McGuire

2002

Journal of Health Economics

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“…Following Keeler et al (1998) and FGM, let q s be the service-specific shadow price the plan sets determining access to care for service s. A patient with a benefit function for service s of v is (·) will receive a quantity of services, m is , determined by:…”

Section: Managed Carementioning

confidence: 99%

Predictability and predictiveness in health care spending

Ellis

McGuire

2007

Journal of Health Economics

100

115

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This paper re-examines the relation between the predictability of health care spending and incentives due to adverse selection. Within an explicit model of health plan decisions about service levels, we show that predictability (how well spending on certain services can be anticipated), predictiveness (how well the predicted levels of certain services contemporaneously co-vary with total health care spending), and demand responsiveness all matter for adverse selection incentives. The product of terms involving these three measures of predictability, predictiveness, and demand responsiveness define an empirical index of the direction and magnitude of selection incentives. We quantify the relative magnitude of adverse selection incentives bearing on various types of health care services in Medicare. Our results are consistent with other research on service-level selection. The index of incentives can readily be applied to data from other payers.

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“…Analogously, the same question can be raised for the outpatient sector and physicians (Mariñoso and Jelovac, 2003;Dusheiko et al, 2006;Karlsson, 2007). Especially in the US-a market still dominated by private health care providers-there is considerable debate surrounding the question of whether Health Maintenance Organizations (HMOs) can help reduce health expenditures while maintaining quality (Goldman et al, 1995;Hill and Wolfe, 1997;Keeler et al, 1998;Deb and Trivedi, 2009). In Europe, on the other hand, key concerns revolve around issues of direct rationing (by public authorities) and indirect rationing (through waiting times) (Propper et al, 2002;Schut and de Ven, 2005;Felder, 2008;Siciliani et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Assessing the Effectiveness of Health Care Cost Containment Measures

Ziebarth

2011

SSRN Journal

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Using SOEP panel data and difference-in-differences methods, this study is the first to empirically evaluate the effectiveness of four different health care cost containment measures within an integrated framework. The four measures investigated were introduced in Germany in 1997 to reduce moral hazard and public health expenditures in the market for convalescent care. Doubling the daily copayments was clearly the most effective cost containment measure, resulting in a reduction in demand of about 20 percent. Indirect measures such as allowing employers to cut statutory sick pay or paid vacation during health spa stays did not significantly reduce demand.

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A model of the impact of reimbursement schemes on health plan choice

Cited by 47 publications

References 13 publications

Multiple payers, commonality and free-riding in health care: Medicare and private payers

Multiple payers, commonality and free-riding in health care: Medicare and private payers

Predictability and predictiveness in health care spending

Assessing the Effectiveness of Health Care Cost Containment Measures

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