Ellis R P
Economics Department, Boston University, MA, USA.
J Health Econ. 1998 Oct;17(5):537-55. doi: 10.1016/s0167-6296(97)00042-8.
Reimbursement incentives influence both the intensity of services and who is treated when patients differ in severity of illness. The social optimum is compared to the private Cournot-Nash solution for three provider strategies: creaming--over-provision of services to low severity patients; skimping--under-provision of services to high severity patients; and dumping--the explicit avoidance of high severity patients. Cost-based reimbursement results in overprovision of services (creaming) to all types of patients. Prospectively paid providers cream low severity patients and skimp high severity ones. If there is dumping of high severity patients, then there will also be skimping.
报销激励措施会影响服务强度，以及在患者病情严重程度不同时谁会得到治疗。针对三种提供者策略，将社会最优解与私人古诺 - 纳什解进行了比较：挑选——向病情较轻的患者过度提供服务；克扣——向病情较重的患者提供不足的服务；以及抛弃——明确避开病情较重的患者。基于成本的报销导致对所有类型的患者都过度提供服务（挑选）。按预期付费的提供者会挑选病情较轻的患者，而克扣病情较重的患者。如果存在对病情较重患者的抛弃，那么也会存在克扣。
