Allard Marie, Jelovac Izabela, Léger Pierre-Thomas
HEC Montréal, 3000, chemin de la Côte-Sainte-Catherine, Montreal, QC , H3T 2A7, Canada,
Int J Health Care Finance Econ. 2014 Jun;14(2):143-60. doi: 10.1007/s10754-014-9143-z. Epub 2014 Mar 27.
This paper analyzes the consequences of allowing gatekeeping general practitioners (GPs) to select their payment mechanism. We model GPs' behavior under the most common payment schemes (capitation and fee for service) and when GPs can select one among them. Our analysis considers GP heterogeneity in terms of both ability and concern for their patients' health. We show that when the costs of wasteful referrals to costly specialized care are relatively high, fee for service payments are optimal to maximize the expected patients' health net of treatment costs. Conversely, when the losses associated with failed referrals of severely ill patients are relatively high, we show that either GPs' self-selection of a payment form or capitation is optimal. Last, we extend our analysis to endogenous effort and to competition among GPs. In both cases, we show that self-selection is never optimal.
本文分析了允许把关全科医生（GP）选择其支付机制的后果。我们对全科医生在最常见支付方案（按人头付费和按服务收费）下以及全科医生可以在其中进行选择时的行为进行建模。我们的分析考虑了全科医生在能力以及对患者健康的关注度方面的异质性。我们表明，当向昂贵的专科护理进行浪费性转诊的成本相对较高时，按服务收费支付方式对于使扣除治疗成本后的患者预期健康净收益最大化而言是最优的。相反，当重症患者转诊失败所带来的损失相对较高时，我们表明要么全科医生自行选择支付形式，要么按人头付费是最优的。最后，我们将分析扩展到内生努力以及全科医生之间的竞争。在这两种情况下，我们都表明自行选择永远不是最优的。
