The impact of private hospital insurance on the utilization of hospital care in Australia

We use the Australian National Health Survey to estimate the impact of private hospital insurance on the propensity for hospitalization as a private patient. We account for the potential endogeneity of supplementary private hospital insurance purchases and calculate moral hazard based on a difference-of-means estimator. We decompose the moral hazard estimate into a diversion component that is due to an insurance-induced substitution away from public patient care towards private patient care, and an expansion component that measures a pure insurance-induced increase in the propensity to seek private patient care. Our results suggest that on average, private hospital insurance causes a sizable and significant increase in the likelihood of hospital admission as a private patient. However, there is little evidence of an expansion effect; the treatment effect of private hospital insurance on private patient care is driven almost entirely by the substitution away from public patient care towards private patient care. We discuss the implications for policies that aim to expand supplementary private insurance coverage for the purpose of reducing excess demand on the public healthcare system.     

生态旅游可持续发展困境:成因及治理——基于信息经济学的分析

生态旅游曾被认为是实现旅游业可持续发展的最好途径,但是由于生态旅游产品具有的经验性商品、产品标准化程度低等的特征,决定了生态旅游的交易双方关于产品质量信息的不对称。而信息不对称又是导致生态旅游市场逆向选择和道德风险的主要原因。文章运用博弈论和信息经济学的相关理论模型,从理论角度论述了我国目前生态旅游可持续发展存在的困境,并基于现实情况提出了相关的治理措施。     

信息不对称条件下我国商业银行信贷资产安全分析

本文从信息经济学和行为金融学的特殊视角探讨了信息不对称条件下我国商业银行信贷资产不安全的形成机理,并创造性地对银行信贷资产安全内涵进行了界定,总结和提出了信贷交易中存在的5种主要信息不对称形式,特别是创新地提出了商业银行与商业银行之间、与信用中介评级机构之间存在的信息不对称问题,对于当前形势下加强和防范信贷经营中的超额授信、过度授信、关联企业等风险具有较强的实践意义.     

风险投资家的最优激励契约模型研究--一种基于逆向选择和道德风险条件下的博弈模型分析

为减少风险投资融资中风险投资家的逆向选择和道德风险,风险投资者必须设立一套有效的激励机制来让风险投资家选择,从而根据风险投资家选择的结果来甄别其真实能力类型,同时又能激励其努力工作。文章建立了风险投资家能力类型和努力都是不可观测条件下的最优激励契约模型,并根据显示原理,利用最优控制理论求出了最优解进而进行了分析。得出的结论是:最优激励契约能使高能力风险投资家乐于选择具有高强度激励、低固定收入和风险小的项目,同时又能激励其签约后更加努力工作。     

基于博弈视角的银企信贷关系分析

银行和企业之间的信贷关系是影响我国经济增长的重要因素。由于信息不对称,银企信贷关系存在着很大的不确定性。本文通过对银企信贷行为的博弈分析,找出信贷风险的存在原因。通过增大企业贷款前的伪装成本,减少企业的逆向选择行为;增大企业贷款后的惩罚成本,减少企业的道德风险行为,从根本上改变银企之间的信息不对称状况,有利于银企关系的良好发展。     

Information Asymmetries and Risk Management in Healthcare Markets: The U.S. Affordable Care Act in Retrospect

This article critically examines the pertinent issues in ex ante and ex post moral hazard in healthcare markets, with the U.S. Affordable Care Act (ACA) as its focal point of inquiry. First, it compares the various types of information asymmetries resulting from the production, allocation, and utilization of health insurance. Second, it reviews the literature on adverse selection, moral hazard, and risk mitigation against which salient ACA reforms are analyzed. In contrasting conventional moral hazard from an alternative theory of welfare maximization, it suggests that healthcare (over)utilization cannot necessarily be considered wasteful, even if it ends up costing insurers more on a short-term basis. Costs and savings attributable to healthcare spending under the ACA will vary between the consumer, insurer, and regulator-subsidizer. Despite the ambiguities surrounding definitions of “health,” the challenge of containing inefficient moral hazard, and encouraging its desirable counterpart, lies in the tradeoffs that arise between consumer access to affordable and quality healthcare and the market competitiveness of health insurers. The new Trump administration will have to address these tradeoffs in repealing and replacing the ACA, particularly in light of escalating insurance premiums and deductibles, narrower provider networks, and technical implementation issues.     

有限信息与假冒伪劣商品的识别

基本竞争模型完全信息的假设与现实相悖:由于信息的真伪难辨;信息收集需要成本;消费者能够记忆并回想的信息有限;消费者对信息的加工能力有限以及信息市场不完善等原因,致使消费者所掌握的信息非常有限.信息有限的结果是市场稀薄和假冒伪劣商品盛行.消费者可以借助担保、信誉、专家、标准以及价格制度等方法去识别假冒伪劣商品.     

道德风险存在下董事责任保险市场的保费水平分析

本文通过对董事责任保险市场的介绍,指出在董事责任保险市场中存在着严重的道德风险问题,通过对市场中保险双方行为的博弈分析,得到在道德风险存在下的保费变动范围,并指出防止或减轻董事责任保险市场中道德风险的方法.     

Hospital patients with severe wounds: early evidence on the impact of Medicare payment changes on treatment patterns and outcomes

Aims: This study examines the effects of recent changes in Medicare long-term care hospital (LTCH) payments on treatment patterns and outcomes for severe wound patients discharged from short-term acute care hospitals (STACHs).

Materials and methods: The rolling implementation of a new Medicare payment policy was used to develop a difference-in-difference model. The study population consisted of Medicare beneficiaries subjected to the payment policy changes and hospitalized for stage 3, 4, or unstageable wounds; non-healing surgical wounds; and fistula. Using 2015-Q1-2017 Medicare claims data, changes in outcomes were examined for severe wound patients exposed to the new policy (treatment) and those that were not (comparison). All outcomes were modeled using linear regressions and adjusted for patient clinical characteristics. Analysis was conducted in a full sample and a sample with high-LTCH-use propensity.

Results: Severe wound patients exposed to the new policy experienced 4.1 and 7.5 percentage point (pp) reductions in LTCH use relative to the comparison group in the full sample and high-LTCH-propensity sample, respectively (p?p?=?.039). No statistically significant change was found in 60-day mortality or Medicare spending after the policy change in the treatment group as compared to the comparison group (p?>?.10). However, among severe wound patients who are exposed to the new policy in the high-LTCH-propensity sample, readmission and post-discharge sepsis rates increased after the policy change relative to the comparison group (readmission rate = 8.1 pp, p?=?.075; sepsis rate = 7.0 pp, p?=?.033).

Limitations: The findings are based on data from a limited timeframe around the policy change and, thus, provide only early evidence on the effects of the new policy.

Conclusion: The new LTCH payment policy is associated with no changes in Medicare spending and mortality, but higher readmissions and post-discharge sepsis rates among severe wound patients with a high likelihood to use an LTCH.     

The impact of frailty on the economic evaluation of geriatric surgery: hospital costs and opportunity costs based on meta-analysis

Abstract

Objectives: We used a systematic review and meta-analysis to analyze the difference in costs between surgery for frail and non-frail elderly patients. The opportunity cost of frailty in geriatric surgery is estimated using the results.

Methodology: Two literature reviews were carried out between 2000 and 2019: (1) studies comparing total hospital costs of frail and non-frail surgical patients; (2) studies evaluating the length of hospital stay and cost for surgical geriatric patients. We performed a meta-analysis of the items selected in the first review. We subsequently calculated the opportunity cost of frail patients, based on the design of a cost/time variable.

Results: Twelve articles in the first review were selected (272,717 non-frail and 16,461 frail). Fourteen articles were selected from the second review. Frail patients had higher hospital costs than non-frail patients (22,282.541 € and 16,388.844, p?<?.001) and a longer hospital stay (10.16 days and 8.4 (p?<?.001)). The estimated opportunity cost in frail patients is 1,019.56 € (cost/time unit factor of 579.30 €/day).

Conclusions: Frail surgical geriatric patients generate a higher total hospital cost, and an opportunity cost arising from not operating in the best possible state of health. Preoperatively treating the frailty of elderly patients will improve the use of health resources     

The impact of prudence on optimal prevention

Summary. What are the determinants of the optimal level of effort to reduce the probability of a loss to occur? Whereas most of the literature on this question focused on risk aversion, we show that the concept of prudence (i.e., a positive third derivative of the utility function) is essential to answer this question. We explain in this paper that prudence and prevention tend to be opponents rather than allies contrary to the intuition attached to everyday language.Received: 7 November 2003, Revised: 3 August 2004, JEL Classification Numbers: D61, D81. Correspondence to: Christian Gollier     

The impact of prudence on optimal prevention revisited

We re-examine the link between absolute prudence and self-protection activities. We show that the level of effort chosen by an agent with decreasing absolute prudence is larger than the optimal effort chosen by a risk-neutral agent if the degree of absolute prudence is less than a threshold that is utility-independent and empirically verifiable.     

The impact of technology imports on technology balance of payments in Korea: an ARDL bounds testing approach

This study empirically analyses the impact of technology imports on the technology balance of payments in Korea during 1981–2013 using the autoregressive distributed lag bounds testing approach of co-integration. We estimate the long- and short-run coefficients of the technology balance of payments with respect to technology imports. The results show that technology imports produce positive effects on the technology balance of payments in the long run, although it has negative effects in the short run.     

The effect of copayments on primary care utilization: results from a quasi-experiment

This article analyses how health-care utilization is affected by copayments in a tax-financed health-care system. The article utilizes a natural experiment in which a health-care region in Sweden changed the price of healthcare in such a way that primary care general physician prices increased by 33%. We use daily visit data in the treatment region and a neighbouring control region where no price change took place and analyse the effect using differences-in-differences as well as differences-in-differences-in-differences models. The results from the preferred models indicate no effect on health-care utilization due to the price change, a result that also holds across different socio-economic subregions in the treatment region.     

The impact of regional competition on the health care industry

We investigate factors that determine firm markups by employing data on prices and quantities of various medical procedures at major hospitals in the United States. We focus on the impact of hospital quality, rival competition and the number of medical procedures upon the health care demand. Our analysis covers health-care markets across the United States with the market definition based upon the hospital referral regions. Our findings highlight potential implications of the relationship between hospital markups and market structure.     

The impact of changing skill levels on optimal nonlinear income taxes

The impact of changing an individual's skill level on the solution to a finite population version of the Mirrlees optimal nonlinear income tax problem with quasilinear-in-leisure preferences is investigated. It is shown that it is possible to sign the directions of change in everyone's optimal consumptions and optimal marginal tax rates in response to such a change.     

The long-run impact of new medical ideas on cancer survival and mortality

ABSTRACT

We test the hypothesis that the arrival of new medical ideas played a major role in the long-run increase in US cancer survival and decline in cancer mortality, by investigating whether the types of cancer (breast, colon, lung, etc.) subject to greater penetration of new ideas, measured using the MEDLINE/PubMED database, had larger subsequent survival gains and mortality reductions, controlling for changing incidence. The 5-year survival rate is strongly positively related to the novelty of ideas in articles published 12–24 years earlier; evidence from case studies that it takes a long time for research evidence to reach clinical practice. Between 1994 and 2008, the 5-year observed survival rate for all cancer sites combined increased from 52.1% to 61.2%. The estimates suggest that about 70% of this increase may have been due to the increase in the novelty of medical ideas 12–24 years earlier. The number of years of potential life lost from cancer before ages 80 and 70 and the number of cancer deaths are inversely related to the novelty of ideas in articles published 12–24 years earlier, conditional on the number of patients diagnosed 1–10 years before and their mean age at time of diagnosis.     

On the Coexistence of Banks and Markets*

We examine the coexistence of banks and financial markets by studying a credit market where the qualities of investment projects are not observable and the investment decisions of entrepreneurs are not contractible. Standard banks can alleviate moral‐hazard problems, while financial markets operated by investment banks can alleviate adverse‐selection problems. In competition, standard banks are forced to increase repayments, since financial markets can attract the highest‐quality borrowers. This, in turn, increases the share of shirkers and may make lending unprofitable for standard banks. The coexistence of financial markets and standard banks is socially inefficient. The same inefficiency may occur with the entrance of sophisticated banks, operating with a combination of rating and ongoing monitoring technologies.     

The impact of labour unions on external auditor selection and audit scope: evidence from the Korean market

We examine whether labour unions influence external auditor selection and audit scope. As a major user group of financial information, labour unions likely demand financial information of high quality and thus high-quality audits. As a union’s request for wage increases is likely strong when a firm is performing well, management facing wage negotiations with the labour union has incentives to manipulate earnings downward and may therefore prefer auditors who allow more discretion. Using union data unique to Korea during 2005–2008, we find that firms with a stronger labour union tend to choose higher-quality auditors (i.e. Big N or industry specialist auditors). We also find that unionization is negatively (positively) associated with positive (negative) abnormal audit fees and audit hours, and the effects are more pronounced when the union is stronger and more active. Given that departures from normal audit fees and audit hours in either direction arguably impair audit quality, this finding is consistent with our prediction of unions’ demand for high-quality audits. Overall, our findings suggest that labour unions play an important role in determining audit quality.