Regulating Providers' Reimbursement in a Mixed Market for Health Care

Hospitals can be reimbursed for their costs in many ways. Several authors have investigated the effects of these reimbursement rules on physician incentives and, therefore, on the quantity of services provided to patients. A form of (linear) cost-sharing tends to emerge as the socially efficient reimbursement policy. We present a model of hospital reimbursement, based on Ellis and McGuire (1986). The new feature is that physicians can supply private health care services to a patient, as well as public sector ones; a common institutional arrangement in many health care systems. We investigate the optimal public sector reimbursement rule given that private market incentives must now be taken into account. Public sector cost-sharing remains socially efficient, but it is generally non-linear: the precise details depend on whether public and private services are substitutes or complements and on the degree of social efficiency achieved in the private sector. Other reimbursement schemes exhibit optimality properties not present in Ellis and McGuire's work.     

Endogenous Choice of Strategic Contracts in a Mixed Duopoly with Bargaining Over Managerial Delegation Contracts

We revisit the endogenous choice problem of strategic contracts for the public firm and the private firm in a managerial mixed duopoly with differentiated goods. We consider the situation wherein the managerial delegation contracts are determined by maximising social welfare within the public firm, which is equal to the objective function of its owner, and through bargaining over the content of managerial delegation contracts between the owner and manager within the private firm. We show that, in equilibrium, when the manager of the private firm has high bargaining power relative to that of the owner, the public firm chooses a price contract, while the private firm chooses a quantity contract. However, there is no equilibrium market structure under the pure strategic contract class when the manager has sufficiently low bargaining power relative to that of the owner.     

Incentive contracts in delegated portfolio management under VaR constraint

This paper studies the incentive effect of linear performance-adjusted contracts in delegated portfolio management under a value-at-risk (VaR) constraint. It is shown that a linear performance-based contract can provide incentives for the portfolio manager to work at acquiring private information under a VaR risk constraint. The expected utility and optimal effort of a risk-averse manager are increasing functions of the return sharing ratio in the contract. However, a risk constraint causes the portfolio manager to reduce effort in gathering private information, suggesting that the VaR constraint increases the moral hazard between the investor and the manager.     

PRIVATE PROVISION OF PUBLIC GOODS AND INFORMATION DIFFUSION IN SOCIAL GROUPS

I describe a dynamic model of costly information sharing where private information affecting collective‐value actions is transmitted by social proximity. Individuals make voluntary contributions toward the provision of a pure public good, and information transmission about quality of provision is a necessary condition for collective provision to take place in a stationary equilibrium. I show that unlike in the case of private goods, better informed individuals face positive incentives to incur a cost to share information with their neighbors and that these incentives are stronger and provision of the pure public good greater the smaller are individuals' social neighborhoods.     

Incentives and managerial effort under competitive pressure: An experiment

We investigate how increased competition affects firm owners׳ incentives and managers׳ efforts in a laboratory experiment. Each owner offers a compensation scheme to his manager in two different conditions: under monopoly and under Cournot duopoly. Following acceptance of the compensation, the manager chooses an effort level to increase the probability of a cost-reduction which affects the firm׳s profit. According to standard theoretical predictions the entry of a rival firm in a monopolistic industry affects negatively both the incentive compensation and the effort level. Our experimental findings show that the entry of a rival firm has two effects on managerial effort: an internalization effect which affects positively the level of effort and an income effect which has a negative impact on effort. The combined outcome of these two effects is neutral with respect to managerial effort: we observe that when competition reduces the firm׳s profit, the owner reacts by offering lower incentives but despite the lower incentives the manager still accepts the contract offer and exerts the same level of effort than under the monopoly condition.     

Bankruptcy as a Control Device in Economies in Transition

We examine in this paper the design of a liquidation, or bankruptcy, policy in a partially centralized economy characterized by imperfect information. We employ a two-period model to analyze the effects of an optimal liquidation rule on the efficiency of resource allocation and choice of managerial effort when managers have private information about effort and firm productivity. First-period investment is used by the regulator to discipline the manager and to extract information. The tradeoff between disciplinary effect and information extraction might be best solved by implementing inefficient liquidation policies. Inefficiencies in liquidation policies can occur even if the regulator believes that he is facing a given type of firm with probability close to one. J. Comp. Econom., June 1995, 20(3), pp. 265-301. Cornell University, Ithaca, New York 14853-7601.     

Labour hoarding,employment and unemployment in British manufacturing industry

The impact of the provision of public infrastructure on private economic activity is examined. Using a flexible functional form of a cost function with public infrastructure as an additional external input the paper estimates the shadow-price of public infrastructure services for the manufacturing, trade and transport and the construction industries. The results indicate significant cost savings that result from the provision of public infrastructure services. In addition, the paper investigates both empirically as well as theoretically, the question whether the neglect of the provision of public capital within the growth accounting framework provides an explanation for the generally observed productivity slowdown.     

The Effect of Privatization on Public Transit Costs

In an effort to reduce operating deficits, increase productivity, and improve the quality of services, the public transit sector has been moving away from public ownership and operation and towards a franchising arrangement whereby a local government authorizes a private firm to manage and operate the city's public transit system. Profit maximization considerations imply that private managers have stronger incentives for cost efficiency. One such example is the city of Indianapolis which began privatization efforts in its transit operations in 1996. Based upon monthly data from January 1991 through March 1997, this study examines the effect of privatization on the city's cost of providing mass transit. The primary implication of the study is that Indianapolis has experienced an annual 2.5% reduction in operating costs since privatizing the management of its public transit system.     

Strategic managerial incentives in a two-period Cournot duopoly

This paper examines the nature of optimal managerial incentives in the context of a duopoly marked by competition between the firm's managers in a dynamic production environment. If the marginal cost of production falls moderately over time or remains unchanged, there exists an equilibrium where one owner requires her manager to maximize profit, whereas the rival-owner requires her manager to maximize sales revenue. The profit-maximizing manager turns his firm into a Stackelberg-leader, while the sales-revenue-maximizing manager turns his firm into a Stackelberg-follower. Further, the profit-maximizing manager may generate a larger firm profit relative to the sales-revenue-maximizing manager.     

Market and public provision in the presence of human capital externalities

For many goods and services, such as health, education, legal services, police protection, the cost incurred by an individual supplier for providing quality is affected by the human capital of her colleagues. The paper shows that this human capital externality is crucial to determine whether such goods and services should be privately or publicly provided. Public and private provisions give individuals different incentives to acquire human capital, and the paper shows that either may be socially preferable, depending on the nature of the human capital externality: private provision of the final goods and services gives stronger incentives to human capital acquisition (and may therefore be socially preferable) if own human capital and one's colleagues' human capital are substitutes, and if suppliers with high human capital benefit more than suppliers with low human capital from their colleagues' human capital, but not excessively so.     

Efficient Mechanisms for Public Goods with Use Exclusions

Constrained efficient provision of an excludable public good is studied in a model where preferences are private information. The provision level is asymptotically deterministic, making it possible to approximate the optimal mechanism with a mechanism that provides a fixed quantity of the good and charges fixed user fees for access. In general, the fixed fees involve third degree price discrimination, but, if names are uninformative about preferences, the analysis provides a justification for average cost pricing.     

Delegation and commitment in durable goods monopolies

This paper studies a simultaneous-move infinite-horizon delegation game in which the principal of a durable goods monopoly entrusts pricing decisions to a manager who enjoys consuming her monetary rewards but dislikes production effort. The delegation contract allows for continual interference with managerial incentives: in each period the principal rewards the manager according to her performance. We show that when the cost of delegation is low relative to profits, the principal can attain the precommitment price plan in a perfect rational expectations equilibrium. The paper analyzes the robustness of this result under alternative specifications of timing and objectives. We also provide a numerical characterization of the equilibrium strategies for the case of linear-quadratic payoffs.     

Access Regulation and the Timing of Infrastructure Investment

This paper examines infrastructure investment incentives under a system of 'regulation by negotiation'. We demonstrate that an appropriately specified access pricing rule can induce private firms to choose to invest at a socially optimal time. The optimal regulatory regime allocates investment costs to the access provider and seeker based on their relative use-values of the facility. It is superior to an unregulated environment because it commits firms ex ante to an access charge that allows for sunk cost recovery. In addition, we show that when the time that access is sought is flexible both replacement- and historical-cost asset valuation methodologies can lead to optimal investment incentives. However, when seeker timing is restricted, historical cost can give rise to distorted incentives.     

Civil service reform,self‐selection,and bureaucratic performance

I use a formal model to analyze the effect of civil service protections on bureaucratic performance. In a two‐period model, a public manager observes a bureaucrat's actions for a period and decides whether to retain or attempt to remove the bureaucrat. Bureaucrats vary in terms of their intrinsic motivation and choose between careers in government or the private sector. I show that bureaucratic performance is greater in any separating equilibrium in which motivated bureaucrats choose government than in all equilibria in which they do not. Stronger civil service protections reduce the amount of effort that motivated bureaucrats must exert to distinguish themselves from their unmotivated peers in order to ensure retention. This strengthens incentives for motivated bureaucrats to choose careers in government. Stronger civil service protections, however, also reduce the ability of public managers to remove unmotivated bureaucrats. These competing effects yield a non‐monotonic and discontinuous relationship between civil service protections and bureaucratic performance. I use the model to analyze recent reforms to U.S. state and federal personnel management that have significantly rolled back traditional job protections.     

Fiscal policy, long‐run growth, and welfare in a stock‐flow model of public goods

Abstract.  We introduce public capital and public services as inputs in an endogenous growth model. We show that the growth rate depends on the apportionment of tax revenues between the accumulation of public capital and the provision of public services. When public spending is financed by proportional income taxes, the growth rate, the level of public spending as a proportion of GDP, the level of investment in public capital as a proportion of total public spending, and the level of private investment as a proportion of total private spending all are lower in the equilibrium outcome than in the optimal outcome. JEL classification: E62, O40     

Keynesian Multipliers, Direct Crowding Out, and the Optimal Provision of Public Goods

This paper studies Keynesian multipliers in a macroeconomic model with monopolistic competition. We allow public and private consumption goods to be perfect substitutes in private utility. This enables us to study the effect of direct crowding out on the size of national income, profit and employment multipliers for a given rise in real public spending. A positive real national income multiplier is obtained if consumers value public consumption less than private consumption. In addition, we determine the effective marginal cost of public funds and the optimal provision of public goods, both in the short run and in the long run.     

EFFECTS OF ASYMMETRIC INFORMATION WITHIN A FIRM ON OLIGOPOLISTIC MARKET OUTCOMES

I analyze the implications of the Laffont–Tirole type agency problems on oligopolistic market outcomes. In the model, a firm's marginal cost is decreasing in managerial effort and is subject to an additive shock. Both managerial effort and the realization of the shock are a manager's private information. A firm first offers a menu of contract to its manager, and then competes in the product market. As in the model of single principal and single agent, the incentive contracts implement efforts that are distorted downward relative to full information. In this model, with multiple agency relationships, an additional source for upward distortion of effort emerges as a result of the interaction in the product market. The results are robust to whether firms compete in price or quantity.     

Perceived quality of public services, liquidity constraints, and the demand of private specialist care

In this article we offer direct evidence on the role of perceived quality differences in publicly provided health care services, in determining the incentive to opt out for private services and, for poor individuals, short-run credit constraints in the access to these services. We concentrate on private specialist care, a category of services for which disparities in the access are highest. We use Bank of Italy—SHIW data to first study the determinants of demand for private and public specialist care, estimating probit and bivariate probit models, and ZIP models. We then apply the Carneiro–Heckman procedure to identify the share of people constrained and study how perceived quality of public services affects the percentage of people short run constrained. Our estimates suggest the presence of large territorial differences, as for the role of income and the quality of public services.     

Open access policies, regulated charges and non-price discrimination in telecommunications

Open access policies in telecommunications, including interconnection and unbundling, are implemented by regulators in an effort to increase competition in the sector. Lack of cooperation from incumbents is pervasive, given their incentives to engage in non-price discrimination and the moral hazard resulting from the inability of regulators to monitor the contract. We build a relationship between the access price and non-price discrimination, neither assuming a pre-determined market strategic interdependence or a specific demand function format. When the access charge is liberalized, the incentive for non-price discrimination disappears. It may be optimal for the regulator to set a second-best regulated access price to avoid non-price discrimination.