American Health Care: the Re-awakening of Competition

The market for health care in America is constantly used as an Aunt Sally by British health economists. But, Dr David Green (above), a political scientist and welfare economist at the IEA, reveals why the American system is hardly a free market and why it has misled debate in the UK.     

Health Care Payment Systems: Cost and Quality Incentives

This paper compares the cost and quality incentive effects of cost reimbursement and prospective payment systems in the health industry. When a provider cannot refuse patients who require high treatment costs or discriminate patients by qualities, optimally designed prospective payments can implement the efficient quality and cost reduction efforts, but cost reimbursement cannot induce any cost incentive. When the provider can refuse expensive patients, implementation of the first best requires a piecewise linear reimbursement rule that can be interpreted as a mixture of pure prospective payment and pure cost reimbursement, Under appropriate conditions, prospective payment can implement the first best even when the provider can use qualities to discriminate patients.     

Quality Competition, Insurance, and Consumer Choice in Health Care Markets

In this model, insurance offering a choice of hospitals is valued because consumers are uncertain which hospital they will prefer ex post. A competitive insurance market facilitates tacit price collusion between hospitals; high margins induce hospitals to compete for customers through overinvestment in quality. Incentives may exist to lock in market share via managed-care plans with less choice and lower prices. As technology becomes more expensive, the market increasingly offers too little choice. A pure managed care market may emerge, with underinvestment in quality. Relative to a pure insurance regime, however, all consumers are better off under managed care.     

The Effects of Competition on Variation in the Quality and Cost of Medical Care

We estimate the effects of hospital competition on the level of and the variation in quality of care and hospital expenditures for elderly Medicare beneficiaries with heart attack. We compare competition's effects on more-severely ill patients, whom we assume value quality more highly, to the effects on less-severely ill, low-valuation patients. We find that low-valuation patients in competitive markets receive less intensive treatment than in uncompetitive markets, but have statistically similar health outcomes. In contrast, high-valuation patients in competitive markets receive more intensive treatment than in uncompetitive markets, and have significantly better health outcomes. Because this competition-induced increase in variation in expenditures is, on net, expenditure-decreasing and outcome-beneficial, we conclude that it is welfare-enhancing. These findings are inconsistent with conventional models of vertical differentiation, although they can be accommodated by more recent models.     

Health Care

A bstract . A broad rational national health care insurance policy for the United States , providing for universal financial access to health care for all citizens, has both "meaning" and "validity" in that it would address actual socioeconomic concerns and could be implemented. It is justified by theories of justice of Rawls and Donaldson as well as by Adam Smith's socioeconomic model. Social consensus in this area accepts the principle of solidarity that individual self-interests may be better served through collective action , especially if such action is tied to competitive rules. Health care, therefore, is evolving as a public or quasi public good. The basic question no longer is whether the U.S. should have universal health care insurance but what specific health care policy the country should adopt in order to strengthen the market system and to maximize social welfare as effectively as possible.     

加强项目成本管理提高建筑企业核心竞争力

随着我国社会主义市场经济体制改革的推进,建筑业市场竞争空前激烈。建筑施工企业的竞争力主要体现在项目成本上,要想在激烈的市场竞争中生存发展并取得优势,就要加强项目成本管理,以成本领先优势作为企业竞争优势的重要内容,构建食业的核心竞争力。     

产品市场竞争、代理成本与企业绩效

本文基于2010—2016年944家A股上市公司财务数据,运用面板固定效应模型实证研究了产品市场竞争、代理成本与企业经营绩效之间的关系。研究表明:(1)代理成本能够显著的降低企业的经营绩效,且代理成本对国有企业经营绩效的负向作用要显著大于非国有企业;产品市场竞争、股权集中度和股权制衡度能够显著降低企业代理成本,相对于国有企业,产品市场竞争对代理成本的负向作用在非国有企业中更为显著;(2)对于国有企业,产品市场竞争能够直接促进企业经营绩效的提高,而对代理成本与经营绩效的影响并不存在显著的调节作用;对于非国有企业,产品市场竞争并不能直接显著的提高企业绩效,而是通过调节作用显著的抑制代理成本对企业绩效的负面作用。     

内部控制、产品市场竞争与代理成本

本文以2012-2016年我国A股上市公司数据为研究样本,探讨内部控制、产品市场竞争与代理成本之间的关系,研究结果表明内部控制可以有效缓解经理人与股东之间的代理冲突,提升信息披露质量。进一步研究发现,在高强度产品市场竞争下,内部控制对代理成本的抑制作用显著降低。在低强度产品市场竞争下,内部控制缓解代理冲突、降低代理成本的效果更加显著。这说明,产品市场竞争在内部控制抑制代理成本的过程中起到了一定的替代作用。     

产品市场竞争、代理成本与企业绩效

本文基于2010—2016年944家A股上市公司财务数据,运用面板固定效应模型实证研究了产品市场竞争、代理成本与企业经营绩效之间的关系。研究表明:(1)代理成本能够显著的降低企业的经营绩效,且代理成本对国有企业经营绩效的负向作用要显著大于非国有企业;产品市场竞争、股权集中度和股权制衡度能够显著降低企业代理成本,相对于国有企业,产品市场竞争对代理成本的负向作用在非国有企业中更为显著;(2)对于国有企业,产品市场竞争能够直接促进企业经营绩效的提高,而对代理成本与经营绩效的影响并不存在显著的调节作用;对于非国有企业,产品市场竞争并不能直接显著的提高企业绩效,而是通过调节作用显著的抑制代理成本对企业绩效的负面作用。     

Competition among Health Maintenance Organizations

We develop a model of competition among health maintenance organizations (HMOs) to analyze the effects of market power, scale economies, and asymmetric knowledge of health risk on market outcomes. We find that competition among HMOs may, but need not, ensure socially preferred outcomes. Market power or scale economies can sometimes admit socially preferred outcomes when they would otherwise not arise. Asymmetric knowledge of health risk may or may not be constraining. When it is constraining, a variety of patterns of incomplete health insurance can arise, along with excessive or insufficient treatment and preventive care for either high-risk or low-risk individuals.     

The American Example in Health Care

Medical provision to British taxpayers under the National Health Service has often been favourably contrasted with the experience of American consumers. Frances Stevens who has worked in the NHS for years suggests from her observation of the American health system that the NHS can learn much from America.     

Network Incentives in Managed Health Care

This paper introduces a theory of network incentives in managed health care. Participation in the plan's network confers an economic benefit on providers; in exchange, the plan expects compliance with its protocols. The network sets a target for the number of outpatient visits in an episode of care. A provider failing to satisfy the target may be penalized by the plan's attempt to direct patients to other providers within its network. There is an equilibrium in which every provider in the network uses the target. We test the theory by observing behavior of providers before and after the introduction of managed mental health care in a large, employed population. Managed care consisted of price reductions, utilization review, and creation of a network. Quantity per episode of care fell sharply after initiation of managed care. We identify a network effect in our empirical work. The results indicate that in this case, network incentives account for most of the quantity reduction due to managed care.     

Mergers and Exclusionary Practices in Health Care Markets

We evaluate the relationship between insurers (payers) and providers of health care (hospitals) when they each have a nonnegligible share of the market. We focus in particular on their incentives to merge and the existence of equilibria where payers offer preferential treatment to a subset of hospitals. We demonstrate that hospitals are more likely to merge without consolidating their capacities the less competitive they are vis-à-vis the payer's market. Payers are more likely to merge without consolidating their capacities the less competitive either the hospitals' or the payers' market is. A given payer follows an exclusionary strategy when its starting bargaining position vis-à-vis hospitals is weak. At such exclusionary equilibria, payers tend to distinguish themselves from neighboring payers by contracting with a different subset of hospitals.     

市场激烈竞争中的公路工程造价控制

本文所提及的成本控制管理是以高速公路路面施工现场管理作为切入点和着力点,论述降低施工成本的途径和措施,是狭义的围绕工程直接费管理的最基础的成本控制管理。     

行业竞争、信息质量与股权资本成本

本文以2003～ 2009年沪深两市A股上市公司为样本,用信息精确度作为信息质量的替代变量,考察了行业竞争、信息质量与股权资本成本之间的关系.研究结果表明,行业竞争越激烈、公开信息质量越高,则股权资本成本越低;私有信息质量对股权资本成本的影响不显著,公开信息质量与私有信息质量之间的互补效应也不会对股权资本成本产生影响.在降低股权资本成本方面,行业竞争程度与公开信息质量之间存在互补关系.     

转移成本、网络兼容与商业银行竞争

本文借助理论模型和经验研究，探讨了客户转移成本和自动柜员机网络兼容性两个问题。研究表明：存款客户转移成本随银行规模增大而提高，贷款客户转移成本随银行规模增大而降低；单向兼容情况下，某家自动柜员机网络单向开放导致自身利润下降。     

American Health Care for All

Proponents of government provision of health care often refer to America as if the uninsured there were left to bieed to death in the streets. David Green, Research Fellow of the IEA, confutes this garish propaganda with the evidence of health core for all.     

Paying For Joint Costs in Health Care

The paper analyzes a regulatory game between a public and a private payer to finance hospital joint costs (mainly capital and technology expenses). The public payer (inspired by the federal Medicare program) may both directly reimburse for joint costs ("pass-through" payments) and add a margin over variable costs paid per discharge, while the private payer can only use a margin policy. The hospital chooses joint costs in response to payers' overall payment incentives. Without pass-through payments, under provision of joint costs results front free-riding behavior of payers and the first-mover advantage of the public payer. Using pass-through policy in its self-interest, the public payer actually may moderate the under provision of joint costs; under some conditions, the equilibrium allocation may be socially efficient. Our results bear directly on directly Medicare policy, which is phasing out pass-through payments.     

Public and Private Provision of Health Care

One of the mechanisms that are implemented in the cost containment movement in the health care sectors in western countries is the definition, by the third-party payer, of a set of preferred providers. The insured patients have different access rules to such providers when ill. The rules specify the copayments patients must pay when using an out-of-plan care provider. This paper studies the competitive process among providers in terms of both prices and qualities. Competition is influenced by the status of providers as in-plan or out-of-plan care providers. Also, there is a moral hazard of provider choice related to the trade-off between freedom to choose and the need to hold down costs. It is possible to achieve the first-best allocation by an appropriate definition of the reimbursement scheme when decisions on prices and qualities are taken simultaneously (as in primary health care sectors). In contrast, some type of regulation is needed to achieve the optimal solution when decisions are sequential (as in specialized health care sectors). We also derive normative conclusions on how price controls should be implemented in some European Union member states.