Why ‘Optimal’ Payment for Healthcare Providers Can Never be Optimal Under Community Rating

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• 作者：Peter Zweifel ; H. E. Frech III
• 刊名：Applied Health Economics and Health Policy
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：14
• 期：1
• 页码：9-20
• 全文大小：496 KB
• 参考文献：1.Chalkley M, Malcomson J. Contracting for health services when patient demand does not reflect quality. J Health Econ. 1998;17:1–19.CrossRef PubMed
  2.Chalkley M, Malcomson J. Contracting for health services with unmonitored quality. Econ J. 1998;108:1093–110.CrossRef
  3.Lerner AP. Economic theory and socialist economy. Rev Econ Stud. 1934;2(1):51–61.CrossRef
  4.Lerner AP. A note on socialist economics. Rev Econ Stud. 1936;4(1):72–6.CrossRef
  5.Zweifel P, Manning WG. Moral hazard and consumer incentives in health care. In: Culyer AJ, Newhouse JP, editors. Handbook of health economics, vol. 1. Boston: North Holland; 2000. p. 409–59.
  6.Zweifel P. The present state of health economics: a critique and an agenda for the future (Editorial). Eur J Health Econ. 2013;14(4):569–71.CrossRef PubMed
  7.Jehle GA, Reny PJ. Advanced microeconomic theory. 2nd ed. Boston: Addison-Wesley; 2001.
  8.Pauly MV. The welfare economics of community rating. J Risk Insurance. 1970;37(3):407–18.CrossRef
  9.Bhattacharya J, Hyde T, Tu P. Health economics. London: Palgrave Macmillan; 2013.
  10.Sean P. Risk adjustment under the ACA: what you can be doing now. New York: Milliman; 2014.
  11.Zweifel P, Breuer M. The case for risk-based premiums in public health insurance. Health Econ Policy Law. 2006;1(2):171–88.CrossRef PubMed
  12.Beck K, Zweifel P, Trottmann M. Risk adjustment in health insurance and its long-term effectiveness. J Health Econ. 2010;29(4):489–98.CrossRef PubMed
  13.Schut E, Greß S, Wasem J. Consumer price sensitivity and social health insurer choice in Germany and The Netherlands. Int J Health Care Finance Econ. 2003;3(2):117–38.CrossRef PubMed
  14.Royalty AB, Solomon N. Health plan choice: price elasticities in a managed competition setting. J Hum Resour. 1999;34(1):1–41.CrossRef
  15.Turner BD, Shinnick ED. The development of the Irish private health insurance market and evidence of selection effects therein. Cork: Working Paper 02-08, Department of Economics, University College Cork; 2008.
  16.Glazer J, McGuire T. Optimal risk adjustment in markets with adverse selection: an application to managed care. Am Econ Rev. 2000;90(4):1055–71.CrossRef
  17.Clemens J. Regulatory redistribution in the market for health insurance. Am Econ J Appl Econ. 2015;7(2):109–34.CrossRef
  18.Frech HE III, Smith MP. Anatomy of a slow-motion health insurance death spiral. N Am Actuar J. 2015;19(1):60–72.CrossRef
  19.Tinbergen J. On the theory of economic policy. Amsterdam: North-Holland; 1954.
  20.Feldstein M. Remarks at the American Economic Association Meetings Honoring Amy Finkelstein, Philadelphia, PA, 2013.
  21.Sculpher M. The cost-effectiveness of preference-based treatment allocation: the case of hysterectomy versus endometrial resection in the treatment of menorrhagia. Health Econ. 1998;7:129–42.CrossRef PubMed
  22.Geruso M. Selection in employer health plans: homogeneous prices and heterogeneous preferences. Austin: University of Texas at Austin working paper; 2013.
  23.Buchmueller TC, Fiebig DG, Jones G, Savage E. Preference heterogeneity and selection in private health insurance: The case of Australia. J Health Econ. 2013;32(5):757–67.CrossRef PubMed
  24.Zweifel P, Breyer F, Kifmann M. Health economics. 2nd ed. New York: Springer; 2009.CrossRef
  25.Lancaster KJ. A new approach to consumer theory. J Polit Econ. 1966;74(2):132–57.CrossRef
  26.Schoder J, Sennhauser M, Zweifel P. Fine-tuning of health insurance regulation—unhealthy consequences for an individual insurer. Int J Econ Bus. 2010;17(3):313–27.CrossRef
  27.Zweifel P, Telser H, Vaterlaus S. Consumer resistance against regulation: the case of health care. J Regul Econ. 2006;29(3):319–32.CrossRef
  28.Andreoni J. Impure altruism and donations to public goods: a theory of warm-glow giving. Econ J. 1990;100(401):464–77.CrossRef
  29.Zweifel P. Managed Care: prescription for failure? Lessons from Switzerland. Cesifo DICE Rep (J Inst Comp). 2013;11(1):27–31.
  30.MacNeil Vroomen J, Zweifel P. Preferences for health insurance and health status: does it matter whether you are Dutch or German? Eur J Health Econ. 2011;12(1):87–95.CrossRef PubMed
  31.Leukert-Becker K, Zweifel P. Preferences for health insurance in Germany and The Netherlands—a tale of two countries. Health Econ Rev. 2014;4(1):22. doi:10.​1186/​s13561-014-0022-6 .PubMedCentral CrossRef PubMed
  32.Halek M, Eisenhauer JG. Demography of risk aversion. J Risk Insurance. 2001;68(1):1–24.CrossRef
  33.Sanger-Katz M. High rate of shopping and switching in obamacare plans is a good sign. New York: New York Times; 2015.
  34.Bundorf MK, Levine J, Neale M. Pricing and welfare in health plan choice. Am Econ Rev. 2012;102(7):3214–48.CrossRef
  35.Dafny L, Ho K, Varela M. Let them have choice: gains from shifting away from employer-sponsored health insurance and toward an individual exchange. Am Econ J Econ Policy. 2013;5(1):32–58.CrossRef
  36.Frech HE III, Zweifel P. Market socialism and community rating in The Affordable Care Act. Santa Barbara: UCSB Discussion Paper; 2014.
  37.Lange O. On the economic theory of socialism. Review of economic studies 4 (1–2) (Oct. 1936, Feb. 1937), 53–71 and 123–142, reprinted with small changes in B. E. Lippincott (Ed.), On the Economic Theory of Socialism. University of Minnesota Press (1938), 55–143.
  38.Leeman WA. Centralized and decentralized economic systems. Chicago: Rand McNally; 1977.
  39.Roemer JE. A future for socialism. Cambridge: Harvard University Press; 1994.CrossRef
  40.Ellis RP, McGuire TG. Optimal payment systems for health services. J Health Econ. 1990;9:375–96.CrossRef PubMed
  41.Eggleston KN. Risk selection and optimal health insurance-provider payment systems. J Risk Insurance. 2000;67(2):173–96.CrossRef
  42.Ma C-TA, McGuire TG. Optimal health insurance and provider payment. Am Econ Rev. 1997;87(4):685–704.
  43.Rose-Ackerman S. Corruption: a study in political economy. New York: Academic; 1978.
  44.Shleifer A, Vishny RW. Corruption. Quart J Econ. 1993;108(3):599–618.CrossRef
  45.Shleifer A, Vishny RW. The politics of market socialism. J Econ Perspect. 1994;8(2):165–76.CrossRef
  46.Zweifel P, Pauly MV. Market outcomes, regulation, and policy recommendations. In: Preker AS, et al., editors. Private voluntary health insurance in development—friend or foe?. Washington DC: The World Bank; 2007. p. 115–45.
  47.Bundorf MK, Herring BH, Pauly MV. Health risk, income, and employment-based health insurance. Forum Health Econ Policy. 2010;13(2):1–35.CrossRef
  48.Bhattacharya J, et al. Best of both worlds: uniting universal coverage and personal choice in health care. Washington, D.C.: American Enterprise Institute; 2013.
  49.Zweifel P. Bonus systems in health insurance: a microeconomic analysis. Health Policy. 1987;7:273–88.CrossRef PubMed
  50.Pauly MV, Kunreuther H, Hirth R. Guaranteed renewability in insurance. J Risk Uncertain. 1995;10(2):143–56.CrossRef
  51.Kotlikoff LJ, Raffelhüschen B. Generational accounting around the globe. Am Econ Rev. 1999;89(2):161–6.CrossRef
  52.Frech HE III, Hopkins S, MacDonald G. The Australian private health insurance boom: was it subsidies or liberalized regulation? Econ Papers. 2003;22(1):58–64.CrossRef
  53.Ellis RP, Savage E. Run for cover now or later? The impact of premiums, threats and deadlines on private health insurance in Australia. Int J Health Care Finance Econ. 2008;8(4):257–77.CrossRef PubMed
  54.Buchmueller TC. Community rating, age-entry rating and adverse selection in private health insurance in Australia. Geneva Papers Risk Insurance Issues Pract. 2008;33(4):588–609.CrossRef
  55.Pauly MV, et al. Responsible National Health Insurance. Washington DC: American Enterprise Institute Press; 1992.
  
• 作者单位：Peter Zweifel (1)
  H. E. Frech III (2)
  
  1. University of Zurich, Zurich, Switzerland
  2. University of California at Santa Barbara, Santa Barbara, CA, USA
  
• 刊物主题：Pharmacoeconomics and Health Outcomes; Quality of Life Research; Health Economics; Health Administration;
• 出版者：Springer International Publishing
• ISSN：1179-1896

文摘

This article extends the existing literature on optimal provider payment by accounting for consumer heterogeneity in preferences for health insurance and healthcare. This heterogeneity breaks down the separation of the relationship between providers and the health insurer and the relationship between consumers and the insurer. Both experimental and market evidence for a high degree of heterogeneity are presented. Given heterogeneity, a uniform policy fails to effectively control moral hazard, while incentives for risk selection created by community rating cannot be neutralized through risk adjustment. Consumer heterogeneity spills over into relationships with providers, such that a uniform contract with providers also cannot be optimal. The decisive condition for ensuring optimality of provider payment is to replace community rating (which violates the principle of marginal cost pricing) with risk rating of contributions combined with subsidization targeted at high risks with low incomes.