514 research outputs found
A reply to "Who would benefit from average value-based pricing?"
No full textThis is a reply to a comment that Coyle (2020) made on our article entitled "Which valued-based price when patients are heterogeneous?" (Levaggi and Pertile, 2020)
Regulating internal markets for hospital care
No full textInternal markets, Asymmetry of Information, Hospital care, I11, I18, D82,
Hospital Health Care: Cost Reimbursement and Quality Control in a Spatial Model with Asymmetry of Information
No full textCompetition in the provision of hospital care: Are mixed markets a valid alternative?
No full textMixed markets for healthcare, where public hospitals compete alongside private ones, are widespread, however, evidence of their desirability is inconclusive. This study, accounts for the observed differences in providers’ objectives and patients’ preferences in the market for hospital care through a spatial competition model with a public provider at the center. We show that a mixed market may be the welfare maximizing choice when some conditions are met; however, we highlight the potential trade-off between quality and other welfare measures. Policymakers that want to introduce competition should try to sustain patient bias for public provision since it increases the average quality of care. They may also consider monopoly franchises to redistribute benefits when mixed markets increase the profit of private providers. Profit retention can also increase quality, but privatization must be partial to maintain the value of public supply
Does Government Expenditure Crowd Out Private Consumption in Italy? Evidence from a Microeconomic Model
No full textAn abnormal expansion of the public sector may create serious problems to the market economy, as the literature suggests. This issue is quite important in countries such as Italy where the size of the public sector and of its debt are quite relevant. In this paper a model, in the microeconomic tradition, is developed and applied to the italian economy using a quite general utility function to represent consumer's behaviour. The aim of the article is to set up a methological framework in which to test for the hypothesis that the provision of public and impure public goods crowds out private consumption. The main result of the analysis is that, in Italy, traditional public goods play a neutral role in expenditure decisions while impure public goods crowd out private consumption. This crowding out is created by over-production of these services; merit goods are direct complements to a wide range of private goods, but this beneficial effect is more than offset by the negative income effect related to their financing.
Spatial Competition Across Borders: The Role of Patients’ Mobility and Institutional Settings
No full textHealth care systems rely on geographical boundaries that secure financial stability and adequate planning. Quality differences across regions often arise for efficiency reasons, causing patient flows if mobility is free. In this paper, a theoretical spatial competition model is developed to study the role of patients’ mobility on quality setting and to draw policy implications on its use as an instrument to reduce disparities, in a setting where regions differ in efficiency, costs, and market structure. From the analysis, it emerges that the institutional setting matters and a trade-off may appear between equity (in terms of quality difference across patients) and welfare (finding an allocation that maximizes social benefits). In a centralized setting, it is optimal to regulate mobility and increase the quality gap, while allowing free mobility calls for a refined quality setting, in which, depending on a balance between costs and benefits, the quality gap may be either increased or decreased. In decentralization the gap is generally lower, compared to centralization: the different consideration of benefits from local quality provision results in higher quality levels where the market structure is vertically integrated
Patients Mobility Across Borders: A Welfare Analysis
No full textWelfare systems are designed on geographical and membership boundaries. In terms of access to health care this implies that, as a general rule, only individuals residing in their national territory can obtain health care from providers located there. However, in the past few years medical tourism has grown at an explosive pace throughout the world and in Europe. Each year in fact a small, but significant number of European citizens seek medical treatment that is financed by their public insurer in another EU country. From an economic point of view, it is important to distinguish between the two following sources of patients’ mobility: a regulated mobility, where the third payer decides to send patients abroad and patients’ choice, where the patient himself decides to seek care abroad. In this article we show how the combined effect of restrictions to the use of health care, transfer prices, and mobility rules determine social welfare and its allocation between Regions. The results are quite interesting: if the price set for these patients is equal to the marginal cost of the more efficient Region, patients’ mobility should be preferred to patients’ choice. On the other hand, if the price is equal to the marginal cost of the less efficient Region, patient choice should be preferred. The other interesting result is a possible trade off between a static model where each Region chooses its level of cost/effectiveness and a more long term situation, where patient mobility determines a common level for this parameter
Strategic costs and preferences revelation in the allocation of resources for health care
No full textInternal market, Asymmetry of information, Intrinsic motivation, I11, I18,
Rent Extraction through Alternative Forms of Competition in the Provision of Paternalistic Goods
No full textWe compare the properties in terms of rent extraction of spatial competition and monopoly franchises using Dutch first price auctions, two of the most widely used tools to regulate public service provision. In a framework where the regulator can imperfectly observe costs, but the latter are not necessarily private information to each competitor, spatial competition is more effective in extracting rent if providers are very different in their productivity and if they can observe the costs of their competitors. When they are quite similar and have limited information on the competitors' characteristics, the use of a monopoly franchise through an auction mechanism should be preferred. In the latter environment, a multiple object auction allows more rent to be extracted from the provider
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