Optimal Contracting with Altruistic Agents: Medicare Payments for Dialysis Drugs

• 成果类型: Article
• 署名作者: Gaynor, Martin; Mehta, Nirav; Richards-Shubik, Seth
• 署名单位: Carnegie Mellon University; National Bureau of Economic Research; Western University (University of Western Ontario); Lehigh University
• 刊物名称: AMERICAN ECONOMIC REVIEW
• ISSN/ISSBN: 0002-8282
• DOI: 10.1257/aer.20210208
• 发表日期: 2023
• 页码: 1530-1571
• 关键词: CLINICAL-PRACTICE RECOMMENDATIONS; chronic kidney-disease; health-care; anemia; incentives; HEMODIALYSIS; COSTS; providers; mechanism; outcomes

摘要

We study health-care provider agency and optimal payments, consid-ering an expensive medication for dialysis patients. Using Medicare claims data we estimate a structural model of treatment decisions, in which providers differ in their altruism and marginal costs, and this heterogeneity is unobservable to the government. In a novel applica-tion of nonlinear pricing methods, we empirically characterize the optimal contracts in this environment. The optimal contracts eliminate medically excessive dosages and reduce expenditures, resulting in approximately $300 million in annual gains from better contracting. This approach could be applied to a broad class of problems in health-care payment policy.