How to Regulate Heterogeneous Hospitals?

In many areas of health care financing, there is controversy over the sources of cost variability and about the respective roles of inefficiency versus legitimate heterogeneity. This paper proposes a payment system that creates incentives to increase hospital efficiency when hospitals are heterogeneous, without reducing the quality of care. We consider an extension of Shleifer's yardstick competition model and apply an econometric approach to identify and evaluate observable and unobservable sources of cost heterogeneity. Moral hazard can be seen as the result of two components: long‐term moral hazard (hospital management can be permanently inefficient) and transitory moral hazard. The latter is linked to the manager's transitory cost‐reducing effort. For instance, he or she can be more or less rigorous each year when bargaining prices for supplies delivered to the hospital by outside firms. The use of a three‐dimensional nested database makes it possible to identify transitory moral hazard and to estimate its effect on hospital cost variability. Econometric estimates are performed on a sample of 7,314 stays for acute myocardial infarction observed in 36 French public hospitals over the period 1994–1997. We obtain two alternative payment systems. The first takes all unobservable hospital heterogeneity into account, provided that it is time invariant, whereas the second ignores unobservable heterogeneity. Simulations show that substantial budget savings—at least 20%—can be expected from the implementation of such payment rules. The first method of payment has the great advantage of reimbursing high‐quality care. It leads to substantial potential savings because it provides incentives to reduce costs linked to transitory moral hazard, whose influence on cost variability is far from negligible. This payment rule could be extended to other areas of health care financing, such as Adjusted Average Per Capita Cost to calculate Medicare Managed Care reimbursements in the United States.     

Long-Term or Short-Term Managerial Incentive Contracts

This paper deals with the strategic role of the temporal dimension of contracts in a duopoly market. Is it better for a firm to sign long-term incentive contracts with managers or short-term contracts? For the linear case, with strategic substitutes (complements) in the product market, the incentive variables are also strategic substitutes (complements). It is shown that a long-term contract makes a firm a leader in incentives, while a short-term contract makes it a follower. We find that, under Bertrand competition, in equilibrium one firm signs a long-term contract and the other firm short-term incentive contracts; however, under Cournot competition, the dominant strategy is to sign long-term incentive contracts.     

Lump‐Sum versus Pay‐As‐You‐Go: The Moderating Effect of Contract Types on the Optimal Logistics Decisions

When outsourcing their logistics operations to transportation companies, manufacturers/retailers need to design a contract, under which payment can be made either in a lump sum or over time (i.e., per each delivery). This paper investigates how the payment method (i.e., type of contracts) impacts the transporter's delivery schedule by developing an analytical model based on the optimal control and game theories. Our findings show that the transporter's delivery schedule depends on the method of payment and the overall cost of hiring a transporter varies with the types of contracts. We provide theoretical explanations to these findings along with managerial implications. Copyright © 2016 John Wiley & Sons, Ltd.     

Career Concerns and Product Market Competition

This paper studies the effect of increased competition in the product market on managerial incentives. I propose a simple model of career concerns where firms are willing to pay for managerial talent to reduce production costs, but also to subtract talented executives from competitors. This second effect is privately valuable to firms, but is socially wasteful. As a result, equilibrium pay for talent can be inefficiently high and career concerns too strong. Explicit incentive contracts do not solve the problem, but equilibrium pay is reduced if managerial skills have firm‐specific components, or if firms are heterogeneous. In this second case, managers are efficiently assigned to firms, but equilibrium pay reflects the profitability of talent outside the efficient allocation. The effect of increased competition is ambiguous in general, and depends on the profit sensitivity to cost reductions. This ambiguity is illustrated in two examples of commonly used models of imperfect competition.     

Motivate and select: Relational contracts with persistent types

We develop a model of relational contracts with moral hazard and asymmetric persistent information about an employee's type. We find that the form of the optimal contract depends on the job characteristics and the distribution of employees' talent. Bonus contracts are more likely to be adopted in complex jobs and when high talent is not too common or too rare. Firms with “normal” jobs are more likely to adopt termination contracts. In labor market equilibrium, different contracts may be adopted by ex ante identical firms. Hence, we offer an explanation for the coexistence of different employment systems within the same industry.     

Trust in Agency

Existing models of the principal–agent relationship assume the agent works only under extrinsic incentives. However, many observed agency contracts take the form of a fixed payment. For such contracts to work, the principal must trust the agent to work in the absence of incentives. I show that agency fosters the advent of intrinsic motivation and trustworthy behavior. Three distinct motivational schemes are analyzed: norms, ethical standards, and altruism. I identify conditions under which these mechanisms arise and show how they promote trust. The analysis alters several important predictions of conventional models: (1) Better outcomes may ensue in highly uncertain environments; (2) the principal is better off the more the agent is risk averse; and (3) larger equilibrium extrinsic incentives need not be associated with larger effort or larger total surplus .     

建设项目成本加酬金合同的激励效用研究

成本加酬金合同是一种常用的建设工程合同类型,应研究其不同激励形式对业主和承包商产生的不同效用.本文基于业主和承包商期望效用,应用委托-代理理论建立了有限责任合同、按固定份额分成合同、按约定公式分成合同等三类合同模式的激励模型.采用规划方法求出模型最优解、并讨论分析激励的实施效用.通过测算各种情况下各模式对业主和承包商的效用,经过求解不等式,可比较出各效用的大小,并可推广到固定总价合同模式.通过建立合同激励模型可进行效用测算,能帮助业主设计既能吸引承包商参与又能扩大业主自身效用的合同模式;也能帮助承包商识别并参与对自身效用较大的合同.     

合同管理在工程造价控制中的作用

工程从开工到竣工,不论是预付款及工程款的支付、竣工结算审核、工程变更签证计价,还是工程变更或其他因素引起的工期、费用索赔等,都是建立在合同条款基础上,因此,施工合同管理对工程造价的确定起着十分重要作用。在这里,浅论一下施工合同管理在工程造价的意义。     

Hospital Reimbursement Incentives: An Empirical Analysis

Reimbursement systems for health-care providers are very complex, like the production systems that they regulate. This complexity has led to some important misperceptions about the incentive consequences of major reimbursement reforms. One example is the prospective payment system (PPS), developed to provide "high-powered" incentives through fixed prices for hospital admissions for the US elderly. In fact, various features of the DRG system allow reimbursement to vary with actual treatment decisions during an admission, and so are not prospective. This paper develops a general method for measuring actual reimbursement incentives in complex regulated price systems. The method uses regression techniques with variance decompositions to quantify the effects of particular features of the payment system on prospective and retrospective cost sharing, as well as overall generosity of payments. I apply this method to microdata on 20 percent of Medicare hospital admissions in 1987 and 1990 to summarize the incentives created by PPS in practice, and how the incentives are evolving over time. I show that PPS involves limited and decreasing cost sharing with hospitals, most of which is not prospective. The reimbursement incentives vary substantially across diagnoses, demographic groups, and types of intensive treatments, possibly with important implications for hospital behavior and medical expenditure growth. The techniques developed here can be used to analyze a broad range of provider reimbursement mechanisms.     

The optimality of public–private partnerships under financial and fiscal constraints

The government may delegate two sequential tasks (e.g., building and operating an infrastructure) to the same or different agents (i.e., partnership vs. sequential contracts). Agents are risk-neutral but face financial constraints, whereas the government's contractual capacity may be limited by the renegotiation-proofness and fiscal constraints. By relying on history-dependent incentives, the partnership contract corrects moral hazard more effectively than sequential contracts. Thus, it is socially preferred unless bundling different tasks deteriorates the agent's financial conditions. Our results shed new light on the role of firms' financial and government's fiscal conditions in driving the cost–benefit analysis of public–private partnerships.     

Measuring Hospital Cost-Sharing Incentives Under Refined Prospective Payment

This paper evaluates the usefulness of a model (McClellan, 1997) that was recently proposed for measuring reimbursement incentives under ongoing refinements to the hospital prospective payment system. The model is applied to a single major disease category (HIV infection) for which the hospital reimbursement system has undergone dramatic refinements in recent years. The paper highlights a problem in the original specification, namely, the use of endogenous costs as an explanatory variable. The paper illustrates how hospital response to both marginal price incentives (e.g., a change in the supply of payment-related services) and average price incentives (e.g., a change in the supply of non-payment-related services) can cause either over-or underestimation of payer cost sharing. In the present case study, overestimation of the marginal reimbursement incentives was evidenced. Obtaining cost-sharing estimates that can be used to evaluate alternative payment classification systems requires controlling for endogenous changes in hospital behavior.     

Managerial incentives for process innovation

Cost‐reducing investments by firms are often not publicly observable. This lack of observability would preclude a strategic use of process innovation. However, we show that an observable and verifiable contract that provides direct monetary incentives for cost reductions — an innovation incentive contract — can act as a strategic commitment device. Our model predicts that manager‐led firms are more innovative than owner‐led firms and that these contracts become less prevalent as product market competition intensifies. Both predictions are consistent with recent empirical evidence. Copyright © 2008 John Wiley & Sons, Ltd.     

Subjective performance of patent examiners,implicit contracts,and self‐funded patent offices

Self‐funded patent offices should be concerned with patent quality (patents should be granted to only deserving innovations) and quantity (as revenues come from fees paid by applicants). In this context, we investigate what is the impact of the self‐funded constraint on different bonus contracts and how these contracts affect the examiners' incentive to prosecute patent applications. We consider contracts in which a patent office offers bonuses on quantity quotas (explicit contract) and on quality outcome (either an implicit contract or an explicit contract based on a quality proxy). We find that a self‐funded constrained agency should make different organization choices of incentives. For a low quality proxy precision, an agency facing a tight budget operates well with implicit contracts. However, by only relaxing moderately the budget constraint, the agency might be worse off simply because this will preclude implicit contracts. Only very large patenting fees might allow the agency to compensate for the loss of implicit contracts.     

Equity‐based incentive contracts and behavior: Experimental evidence

Equity ‐ based incentive contracts provide managers with dual incentives, motivating both effort and fraud. We report the results from an experiment in which manager subjects make effort and fraud decisions that affect a firm's value. The main treatment variable is the incentive contract, which can be of either the simple equity or stock option type. We find that both effort and fraud are increasing in a manager's share of equity and decreasing in the strike price of an option. Interestingly, the stock option contract induces relatively more fraud than the simple equity contract, even though the two induce the same effort.     

Altruism and Relational Incentives in the Workplace

This paper studies how altruism between managers and employees affects relational incentive contracts. To this end, we develop a simple dynamic principal–agent model where both players may have feelings of altruism or spite toward each other. The contract may contain two types of incentives for the agent to work hard: a bonus and a threat of dismissal. We find that altruism undermines the credibility of a threat of dismissal but strengthens the credibility of a bonus. Among others, these two mechanisms imply that higher altruism sometimes leads to higher bonuses, whereas lower altruism may increase productivity and players' utility in equilibrium.     

不同质产品市场Stackelberg博弈模型

一个不同质产品市场中，两企业只能选择产量或价格中的一个为决策变量进行Stackelberg竞争，没有生产能力限制。均衡结果为产品可替代（互补）时，领头企业和尾随企业都将选择产量（价格）为决策变量，存在“先动优势”。     

Separating contract from governance

This paper contends that there is an important distinction between governance structure and contractual form, and that organizational boundaries, defined by governance structures, need not explain contractual form. The basic idea is that governance refers to the general environments and instruments that structure and ‘govern’ specific terms of trade negotiated in ‘contracts’. Problems of verifiability and observability of contractual performance are hypothesized to drive the differential effects on governance structure and contractual form. Specifically, transaction cost factors known to result in employment as a general governance structure do not automatically result in contracts characterized by the payment of fixed‐wages. Instead, incentive pay and the delegation of decision‐making authority to workers may be preferred by firm owners. The paper proposes that the relationship between a firm and a worker involves a two part decision‐making framework in which one choice is the type of governance that structures the second choice regarding the specific characteristics of the contract linking the worker to the firm. Copyright © 2000 John Wiley & Sons, Ltd.     

考虑政府补贴的绿色供应链契约分析及优化研究

以政府、供应商和制造商组成的绿色供应链为研究对象,探讨政府补贴和供应链契约对绿色供应链绩效的影响。构建了批发价格契约、收益共享契约和数量折扣契约模型,比较分析了不同契约下各主体效益及契约选择偏好,设计了收益共享且绿色投入成本共担契约来提高供应链绩效。研究发现:消费者绿色偏好越强烈,产品绿色度和供应链各主体效益越高;当产品绿色度相等时,制造商更倾向于选择批发价格契约,而供应商和政府更倾向于选择收益共享契约或数量折扣契约;相较于其他契约,设计的收益共享且绿色投入成本共担契约可以提高产品绿色度和企业效益。本文为考虑政府补贴的绿色供应链企业决策及选择合理的合作契约提供了理论支持。     

企业融资交易的契约安排：一个交易费用经济学的分析框架

交易费用经济学理论将股权契约和债权契约视为对融资交易不同的契约治理结构。债权契约具有古典契约的特征,是一种按规则运作的契约治理结构;股权契约具有弹性治理的特征,是一种关系型契约治理结构。依据交易费用经济学理论关于交易与契约匹配的一般机理,可以得出融资交易的契约安排机理:低资产专用性融资交易选择债权契约,高资产专用性融资交易选择股权契约,中等资产专用性融资交易选择混合性融资契约,这既可达到交易费用的最小化,又可实现交易效率的最大化。究竟哪类契约在现实融资契约安排中占主导地位,这取决于融资交易包含的资产专用性大小。     

Personalauswahl durch Self-Selection-Strategien: Traditionelle Konzepte und Ansätze zu deren Weiterentwicklung

Economic literature deals with self-selection strategies to overcome quality uncertainty in the application process. Self-selection strategies are beased on the informational impact of an applicant’s preference of a contract within a set of different contracts. If applicants of different qualities prefer different contracts, a seperating equilibrium occurs. In reality self-selection strategies are rarely used by companies. This paper analyses two possibilities to develop theoretical approaches so that they may be useful devices in practical staff selection.