Sticking points: common-agency problems and contracting in the US healthcare system

• 成果类型: Article
• 署名作者: Frandsen, Brigham; Powell, Michael; Rebitzer, James B.
• 署名单位: Brigham Young University; Northwestern University; Boston University; National Bureau of Economic Research
• 刊物名称: RAND JOURNAL OF ECONOMICS
• ISSN/ISSBN: 0741-6261
• DOI: 10.1111/1756-2171.12269
• 发表日期: 2019
• 页码: 251-285
• 关键词: limited-liability; program savings; medicare; QUALITY; performance; continuity; physicians; welfare; pay

摘要

We propose a common-agency model for explaining inefficient contracting in the US healthcare system. Common-agency problems arise when multiple payers seek to motivate a provider to invest in improved care coordination. We highlight the possibility of sticking points, that is, Pareto-dominated equilibria in which payers coordinate around contracts which give weak incentives to the provider. Sticking points rationalize three hard-to-explain features of the US healthcare system: widespread fee-for-service arrangements; problematic care coordination; and the historical reliance on single-specialty practices to deliver care. The model also analyzes the effects of policies promoting more efficient contracting between payers and providers.