More preventive care, and fewer emergency room visits and prescription drugs--health care utilization in a consumer-driven health plan

Although consumer-driven health plans (CDHPs) have grown dramatically, the question of whether CDHPs have reduced health care costs has not been answered definitively. This article presents what the authors believe to be the first study to analyze a large sample of claims data and to look in detail at different types of utilization among enrollees in a CDHP and those in a traditional comprehensive major medical (CMM) plan. After adjusting for the finding that CDHP enrollees are both younger and healthier than those in CMM plans, the authors found that CDHP enrollees show no consistent or significant utilization differences for measures over which consumers have little control (e.g., inpatient stays); lower utilization for measures over which consumers have greater control (e.g., emergency room visits); and higher utilization of preventive services.     

The role of risk in contract choice

Structuring contracts to share risk in light of incentive problemsis the central premise of contract theory, yet the risk-sharingimplications have rarely been thoroughly tested using micro-levelcontract data. In this article we test the major implicationsof a principal-agent model of contracts using detailed dataon more than 4000 individual contracts from modern North Americanagriculture. On a case-by-case basis, our evidence fails tosupport the standard principal-agent model with risk aversionas an explanation of contract choice in modern North Americanfarming. At the same time, we find some support for models thatassume risk-neutral contracting parties and stress multiplemargins for moral hazard and enforcement costs.