The optimality of hospital financing system: the role of physician–manager interactions

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• 作者：David Crainich (1)
  Hervé Leleu (1)
  Ana Mauleon (2) (3)
  
• 关键词：Hospital’s financing system ; Strategic interaction ; Prospective payment system ; H51 ; I18 ; D21
• 刊名：International Journal of Health Care Finance and Economics
• 出版年：2008
• 出版时间：December 2008
• 年：2008
• 卷：8
• 期：4
• 页码：245-256
• 全文大小：167KB
• 参考文献：1. Boadway R., Marchand M. and Motohiro S. (2004). An optimal contract approach to hospital financing. / Journal of Health Economics 23: 85-10 CrossRef
  2. Chalkley M. and Malcomson J.M. (1998). Contracting for health services with unmonitored quality. / Economic Journal 108: 1093-110 CrossRef
  3. Custer W.S., Moser J.W., Musacchio R.A. and Willke R.J. (1990). The production of health care services and changing hospital reimbursement–the role of hospital–medical staff relationships. / Journal of Health Economics 9: 167-92 CrossRef
  4. Dor A. and Watson H. (1995). / The hospital–physician interaction in U.S. hospitals: Evolving payment schemes and their incentives. European Economic Review 39(3/4): 795-02
  5. Harris J.E. (1977). The internal organization of hospitals: Some economic implications. / Bell Journal of Economics 3(1): 467-85 CrossRef
  6. Ma C.A. (1994). Health care payment systems: Cost and quality incentives. / Journal of Economics and Management Strategy 8(2): 93-12
  7. Newhouse J.P. (1996). Reimbursing health plans and health providers: Selection versus efficiency in production. / Journal of Economic Literature 34: 1236-263
  8. Pope G.C. (1990). Using hospital-specific costs to improve the fairness of prospective reimbursement. / Journal of Health Economics 9: 237-51 CrossRef
  
• 作者单位：David Crainich (1)
  Hervé Leleu (1)
  Ana Mauleon (2) (3)
  
  1. CNRS/LEM and IESEG School of Management, Université Catholique de Lille, Lille, France
  2. FNRS and CEREC, Facultés Universitaires Saint-Louis, Brussels, Belgium
  3. CORE, University of Louvain, Louvain, Belgium
  

文摘

The ability of a prospective payment system to ensure an optimal level of both quality and cost reducing activities in the hospital industry has been stressed by Ma (Ma, J Econ Manage Strategy 8(2):93-12, 1994) whose analysis assumes that decisions about quality and costs are made by a single agent. This paper examines whether this result holds when the main decisions made within the hospital are shared between physicians (quality of treatment) and hospital managers (cost reduction). Ma’s conclusions appear to be relevant in the US context (where the hospital managers pay the whole cost of treatment). Nonetheless, when physicians partly reimburse hospitals for the treatment cost as it is the case in many European countries, we show that the ability of a prospective payment system to achieve both objectives is sensitive to the type of interaction (simultaneous, sequential or joint decision-making) between the agents. Our analysis suggests that regulation policies in the hospital sector should not be exclusively focused on the financing system but should also take the interaction between physicians and hospital managers into account.