Overcoming resistance against managed care – insights from a bargaining model

Abstract

Recent healthcare reforms have sought to increase efficiency by introducing managed care (MC) while respecting consumer preferences by admitting choice between MC and conventional care. This article proposes an institutional change designed to let German consumers choose between the two settings through directing payments from the Federal Health Fund to social health insurers (SHIs) or to specialized MC organizations (MCOs). To gauge the chance of success of this reform, a game involving a SHI, a MCO, and a representative insured (RI) is analyzed. In a “three-player/three-cake” game the coalitions {SHI, MCO}, {MCO, RI}, and {SHI, RI} can form. Players’ possibility to switch between coalitions creates new outside options, causing the conventional bilateral Nash bargaining solution to be replaced by the so-called von Neumann-Morgenstern triple. These triples are compared to the status quo (where the RI has no threat potential) and related to institutional conditions characterizing Germany, the Netherlands, and Switzerland.

How Can China’s New Health Care Reform Promote the Balance of Interest Game?–Based on Game Evolution and Simulation Analysis

“… 41 In promoting medical reform, the bargaining model can facilitate multilateral Nash negotiations, leading to a win-win situation for medical, medical insurance, and policyholders. 42 In promoting hierarchical diagnosis and treatment and accessibility of medical services, China has continuously adjusted and balanced the interests of the government, medical institutions, and patients, hoping to achieve the best results. 43 More and more countries use medical insurance payments as the primary means to guide and ensure the success of medical reforms from the rational payment of medical insurance funds.…”

Ausbau Von Primärversorgungseinheiten In Österreich – Ein Spieltheoretischer Ansatz

“…Schaut man sich die Digitalisierungsstrategie und vorhandene eHealth-Anwendungen an, so lässt sich festhalten, dass Österreich zwar seit 2015 eine elektronische Gesundheitsakte (ELGA) vorweisen kann, es aber bisher keinen landesweiten integrierten und sicheren Austausch von Gesundheitsinformationen gibt wie beispielsweise in Estland [16]. Nicht zuletzt die Covid-Pandemie hat jedoch dafür gesorgt, dass 2020 der elektronische Impfpass und 2022 das E-Rezept flächendeckend eingeführt wurden [17].…”