UMIT-University for Health Sciences, Medical Informatics and Technology, Institute for Management and Economics in Healthcare, Hall in Tirol, Austria.
University of Innsbruck, Innsbruck, Austria.
Health Econ. 2021 May;30(5):951-971. doi: 10.1002/hec.4232. Epub 2021 Feb 15.
This paper investigates the impact of monitoring institutions on market outcomes in health care. Healthcare markets are characterized by asymmetric information. Physicians have an information advantage over patients with respect to appropriate treatments, which they may exploit through over- or under-provision or by overcharging. We introduce two types of costly monitoring: endogenous and exogenous monitoring. When monitoring detects misbehavior, physicians have to pay a fine. Endogenous monitoring can be requested by patients, while exogenous monitoring is performed randomly by a third party. We present a toy model that enables us to derive hypotheses and test them in a laboratory experiment. Our results show that introducing endogenous monitoring reduces the level of undertreatment and overcharging. Even under high monitoring costs, the threat of patient monitoring is sufficient to discipline physicians. Exogenous monitoring also reduces undertreatment and overcharging when performed sufficiently frequently. Market efficiency increases when endogenous monitoring is introduced and when exogenous monitoring is implemented with sufficient frequency. Our results suggest that monitoring may be a feasible instrument to improve outcomes in healthcare markets.
本文研究了监督机构对医疗保健市场结果的影响。医疗保健市场的特点是信息不对称。医生在适当的治疗方面相对于患者具有信息优势，他们可能会通过过度或不足的提供或过高的收费来利用这种优势。我们引入了两种类型的昂贵监测：内生监测和外生监测。当监测发现不当行为时，医生必须支付罚款。内生监测可以由患者请求，而外生监测则由第三方随机进行。我们提出了一个玩具模型，使我们能够推导出假设，并在实验室实验中进行测试。我们的结果表明，引入内生监测可以降低治疗不足和过度收费的程度。即使在高监测成本下，患者监测的威胁也足以约束医生。当外生监测足够频繁地进行时，也会减少治疗不足和过度收费。当引入内生监测和当外生监测以足够的频率实施时，市场效率会提高。我们的结果表明，监测可能是改善医疗保健市场结果的可行手段。
