School of Industrial Engineering, Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USA.
Health Econ. 2014 Apr;23(4):397-409. doi: 10.1002/hec.2920. Epub 2013 Apr 4.
Incentives created through contracts can be used as a means of decentralized control in healthcare systems to ensure more efficient healthcare. In this paper, we consider an insurer contracting with a consumer and a provider. We focus on the trade-off between ex ante moral hazard and insurance, and consider both consumer and provider incentives in the insurer's contracting problem in the presence of unobservable preventive efforts. We study two cases of provider efforts: those that complement consumer efforts and those that substitute for consumer efforts. In the first case, our results show that the provider must have greater incentives when the consumer is healthy to induce effort and that inducing provider effort allows an insurer to offer a more complete insurance contract relative to the bilateral benchmark. In the second case, we state conditions under which these conclusions continue to hold. On the basis of our findings, we discuss the implications and challenges of multilateral contracting in practice.
通过合同激励可以作为医疗保健系统去中心化控制的一种手段，以确保更高效的医疗保健。本文中，我们考虑了一个保险公司与消费者和提供商签订合同的情况。我们关注的是事前道德风险和保险之间的权衡，并在存在不可观测的预防措施的情况下，考虑了保险商在其合同问题中对消费者和提供商激励的平衡。我们研究了提供商努力的两种情况：与消费者努力互补和替代消费者努力。在第一种情况下，我们的结果表明，当消费者健康时，提供商必须有更大的激励来促使其努力，并且促使提供商努力可以使保险公司相对于双边基准提供更完整的保险合同。在第二种情况下，我们说明了在这些结论仍然成立的情况下的条件。根据我们的发现，我们讨论了实践中多边合同的含义和挑战。
