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21
Moonlighting: Public Service and Private Practice”.
, 2006
"... Abstract We study dual job incentives with a focus on public-service physicians referring patients to their private practices. We call this moonlighting. Not all physicians moonlight; we introduce a group of dedicated doctors who in the base models behave sincerely in the public system. Allowing mo ..."
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Cited by 27 (5 self)
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Abstract We study dual job incentives with a focus on public-service physicians referring patients to their private practices. We call this moonlighting. Not all physicians moonlight; we introduce a group of dedicated doctors who in the base models behave sincerely in the public system. Allowing moonlighting always enhances aggregate consumer welfare. The equilibrium care quality in the public system may increase or decrease; in the former situation, the policy allowing moonlighting improves each consumer's expected utility. Unregulated moonlighting may be detrimental to consumer welfare when it leads to adverse behavioral reactions such as moonlighters shirking more in the public system, and dedicated doctors abandoning their sincere behavior. Price regulation in the private market tradeoffs the efficiency gain from moonlighting against the loss due to adverse behavior in the public system and improve consumer welfare.
Gatekeeping in Health Care ∗
, 2003
"... We study the competitive effects of restricting direct access to secondary care by gatekeeping, focusing on the informational role of gatekeeping general practitioners (GPs). We consider a secondary care market with two hospitals choosing the quality and specialisation of their care. GPs perfectly o ..."
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Cited by 15 (6 self)
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We study the competitive effects of restricting direct access to secondary care by gatekeeping, focusing on the informational role of gatekeeping general practitioners (GPs). We consider a secondary care market with two hospitals choosing the quality and specialisation of their care. GPs perfectly observe the diagnosis of a patient and the exact characteristics of the secondary care market. Patients are either informed or uninformed when accessing the hospital market. We consider two distinct cases: first, we let the fraction of informed patients be exogenous, implying that the regulator can only influence patients ’ decision of consulting a GP by making this compulsory (‘direct gatekeeping’). Second, we endogenise this fraction by assuming GP consultation to be costly for the patient. Then the regulator can influence the GP attendance rate through the regulated price (‘indirect gatekeeping’). A main finding of the paper is that strict gatekeeping may not be socially desirable, even if it is costless.
Public rationing and private cost incentives
, 2003
"... This paper considers a public provider’s strategic use of rationing in a market served by both public and private providers. Such a ‘mixed’ market structure is common in many industries such as health care, telecommunication, postal service, and public utilities. The technology in the private sector ..."
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Cited by 5 (2 self)
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This paper considers a public provider’s strategic use of rationing in a market served by both public and private providers. Such a ‘mixed’ market structure is common in many industries such as health care, telecommunication, postal service, and public utilities. The technology in the private sector exhibits increasing returns: each firm can expend ‘effort’ in the form of fixed cost to reduce the marginal cost. Firms in the contestable private sector compete and the market equilibrium is characterized by average-cost pricing. The equilibrium private sector market size is too low, resulting in deficient cost effort. Efficient rationing forces more consumers to use the private sector, restoring cost incentives and implementing the first best. Random rationing may reduce cost inefficiency but does not implement the first best.
Competition and quality in regulated markets: a differential game approach, CEPR w.p
, 2008
"... This series consists of papers with limited circulation, intended to stimulate discussion. Competition and quality in regulated markets: a differential-game approach ..."
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Cited by 4 (3 self)
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This series consists of papers with limited circulation, intended to stimulate discussion. Competition and quality in regulated markets: a differential-game approach
2006, “Competition in the Health Care markets: a “Two-Sided” Approach”, Working Paper
"... Two identical hospitals compete for patients and doctors choosing locations (e.g. specializations) on a Hotelling line, and selecting the quality of the treatment and the salary for the doctors. Patients pay the price chosen by a benevolent central planner. Introducing the presence of cross-group ex ..."
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Cited by 4 (0 self)
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Two identical hospitals compete for patients and doctors choosing locations (e.g. specializations) on a Hotelling line, and selecting the quality of the treatment and the salary for the doctors. Patients pay the price chosen by a benevolent central planner. Introducing the presence of cross-group externalities for the patients (i.e. ceteris paribus patients prefer the hospital with the highest number of doctors), we show that in equilibrium hospitals always maximally differentiate their services. The regulator, choosing the price, can affect only the provision of quality that, in equilibrium, may be provided at the socially optimal level.
Yardstick Competition and Quality
- Journal of Economics and Management Strategy
, 2009
"... This paper examines regulation of cost and quality when firms have private, corre-lated information about productivity and the regulator receives a signal about quality. Incomplete information leads to downward distortions of effort and quality, which is partially offset by the introduction of yards ..."
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Cited by 2 (0 self)
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This paper examines regulation of cost and quality when firms have private, corre-lated information about productivity and the regulator receives a signal about quality. Incomplete information leads to downward distortions of effort and quality, which is partially offset by the introduction of yardstick competition. Under optimal yard-stick competition, the higher is (firm-specific) productivity the more should the firm spend on quality improvement and the more efficiently should it produce. If firms in addition compete for customers, the firm with the highest relative productivity spends the most on quality improvement.
Selecting Negotiation Processes with Health Care Providers ∗
, 2000
"... We address the question of how a third-party payer (e.g. an insurer) decides what providers to contract with. Three different mechanisms are studied and their properties compared. A first mechanism consists in the thirdparty payer setting up a bargaining procedure with both providers jointly and sim ..."
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Cited by 2 (1 self)
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We address the question of how a third-party payer (e.g. an insurer) decides what providers to contract with. Three different mechanisms are studied and their properties compared. A first mechanism consists in the thirdparty payer setting up a bargaining procedure with both providers jointly and simultaneously. A second mechanism envisages the outcome of the same simultaneous bargaining but independently with every provider. Finally, the last mechanism is of different nature. It is the so-called “any willing provider ” where the third-party payer announces a contract and every provider freely decides to sign it or not. The main finding is that the decision of the third-party payer depends on the surplus to be shared. When it is relatively high the third-party payer prefers the any willing provider system. When, on the contrary, the surplus is relatively low, the third-party payer will select one of the other two systems according to how bargaining power is distributed.
Hotelling's Location Model with Quality Choice in Mixed
"... We investigate a mixed duopoly market by introducing quality choice into the Hotelling-type spatial competition model with linear transportation costs. We show that there does not exist a subgame perfect Nash equilibrium (SPNE) of location choice in the three-stage game that is location-then-quality ..."
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Cited by 1 (0 self)
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We investigate a mixed duopoly market by introducing quality choice into the Hotelling-type spatial competition model with linear transportation costs. We show that there does not exist a subgame perfect Nash equilibrium (SPNE) of location choice in the three-stage game that is location-then-quality choice and subsequent price choice. Moreover, we show the conditions of the existence of the quality equilibrium.
Int J Health Care Finance Econ (2011) 11:245–265 DOI 10.1007/s10754-011-9101-y Market conditions and general practitioners ’ referrals
"... Abstract We study how market conditions influence referrals of patients by general prac-titioners (GPs). We set up a model of GP referral for the Norwegian health care system, where a GP receives capitation payment based on the number of patients in his practice, as well as fee-for-service reimburse ..."
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Abstract We study how market conditions influence referrals of patients by general prac-titioners (GPs). We set up a model of GP referral for the Norwegian health care system, where a GP receives capitation payment based on the number of patients in his practice, as well as fee-for-service reimbursements. A GP may accept new patients or close the practice to new patients. We model GPs as partially altruistic, and compete for patients. We show that a GP operating in a more competitive market has a higher referral rate. To compete for patients and to retain them, a GP satisfies patients ’ requests for referrals. Furthermore, a GP who faces a patient shortage will refer more often than a GP who does not. Tests with Norwegian GP radiology referral data support our theory.
quality differentiation, mixed duopoly Corresponding Authors:
, 2014
"... We analytically characterize the effects of ownership and competition in the health care industry on quality provision, market coverage and optimal co-payment policy. A private monopoly selects a lower quality than a public supplier, and the socially optimal co-payment rate with a private monopoly e ..."
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We analytically characterize the effects of ownership and competition in the health care industry on quality provision, market coverage and optimal co-payment policy. A private monopoly selects a lower quality than a public supplier, and the socially optimal co-payment rate with a private monopoly exceeds that with a public monopoly. We establish that the optimal co-payment policy is invariant to the introduction of private competition. Thus, market coverage is invariant to the introduction of competition, whereas all consumers with a higher willingness to pay for quality are better off with competition.
