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Essays on Financial Incentives in Healthcare.

Record Type:	Electronic resources : Monograph/item
Title/Author:	Essays on Financial Incentives in Healthcare./
Author:	Acquatella, Angie.
Published:	Ann Arbor : ProQuest Dissertations & Theses, : 2021,
Description:	113 p.
Notes:	Source: Dissertations Abstracts International, Volume: 83-02, Section: B.
Contained By:	Dissertations Abstracts International83-02B.
Subject:	Health care management. -
Online resource:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=28499241
ISBN:	9798534670882

Essays on Financial Incentives in Healthcare.
Acquatella, Angie.

Essays on Financial Incentives in Healthcare. - Ann Arbor : ProQuest Dissertations & Theses, 2021 - 113 p.

Source: Dissertations Abstracts International, Volume: 83-02, Section: B.

Thesis (Ph.D.)--Harvard University, 2021.

This item must not be sold to any third party vendors.

This dissertation presents three essays on provider payment contracts, focusing on the implications of contract design on the healthcare delivered and the costs of insurance. The first chapter proposes a theoretical framework for designing insurer reimbursement contracts. There is little consensus among insurers on how to reimburse providers, suggesting that relevant contracting metrics are not well understood. My theory suggests that dispersion in treatment needs is a critical determinant for the costs of the payment system, explaining why prospective payment contracts may issue outlier payment adjustments, optimally. The model combines two elements that yield new theoretical results: provider altruism and unobserved patient heterogeneity.Provider altruism is a source of inefficient over-treatment, and treatment caps can efficiently contain overall health care delivery when patient benefits are unobservably disperse. The second chapter proposes a method for evaluating the optimality of provider reimbursement contracts that are partially retrospective, meaning that they condition payment on ex-post reported costs. In a setting where patients heterogeneously benefit from medical care, I derive the optimal linear reimbursement contract for an insurer maximizing the aggregate health of his patients. Then, I propose two ways to empirically calibrate the optimality condition of the insurer with respect to the component of the contract that reimburses retrospectively. I apply one method to the Medicare Outpatient Prospective Payment System, and find that payments are too prospective. The study of the linear contract also provides new theoretical reasons for why insurers may want partially retrospective reimbursements when provider moral hazard is small. The third chapter studies the effects of the Medicare Part B reimbursement formula for drugs, which depends on the lagged average sales price, on dynamic pricing incentives for physician administered drugs. I document evidence that prices for monopoly drugs covered under Medicare Part B evolve according to steep, upward sloping paths, which seems puzzling in light of existing theories about lagged price reimbursement which have been proposed to explain high launch prices. I present competing theories that can help reconcile both the steep price increases and high launch prices.

ISBN: 9798534670882Subjects--Topical Terms:

2122906
Health care management.
Subjects--Index Terms:

Contracting

Essays on Financial Incentives in Healthcare.
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245 1 0 $a Essays on Financial Incentives in Healthcare.
260 1 $a Ann Arbor : $b ProQuest Dissertations & Theses, $c 2021
300 $a 113 p.
500 $a Source: Dissertations Abstracts International, Volume: 83-02, Section: B.
500 $a Advisor: Cutler, David.
502 $a Thesis (Ph.D.)--Harvard University, 2021.
506 $a This item must not be sold to any third party vendors.
520 $a This dissertation presents three essays on provider payment contracts, focusing on the implications of contract design on the healthcare delivered and the costs of insurance. The first chapter proposes a theoretical framework for designing insurer reimbursement contracts. There is little consensus among insurers on how to reimburse providers, suggesting that relevant contracting metrics are not well understood. My theory suggests that dispersion in treatment needs is a critical determinant for the costs of the payment system, explaining why prospective payment contracts may issue outlier payment adjustments, optimally. The model combines two elements that yield new theoretical results: provider altruism and unobserved patient heterogeneity.Provider altruism is a source of inefficient over-treatment, and treatment caps can efficiently contain overall health care delivery when patient benefits are unobservably disperse. The second chapter proposes a method for evaluating the optimality of provider reimbursement contracts that are partially retrospective, meaning that they condition payment on ex-post reported costs. In a setting where patients heterogeneously benefit from medical care, I derive the optimal linear reimbursement contract for an insurer maximizing the aggregate health of his patients. Then, I propose two ways to empirically calibrate the optimality condition of the insurer with respect to the component of the contract that reimburses retrospectively. I apply one method to the Medicare Outpatient Prospective Payment System, and find that payments are too prospective. The study of the linear contract also provides new theoretical reasons for why insurers may want partially retrospective reimbursements when provider moral hazard is small. The third chapter studies the effects of the Medicare Part B reimbursement formula for drugs, which depends on the lagged average sales price, on dynamic pricing incentives for physician administered drugs. I document evidence that prices for monopoly drugs covered under Medicare Part B evolve according to steep, upward sloping paths, which seems puzzling in light of existing theories about lagged price reimbursement which have been proposed to explain high launch prices. I present competing theories that can help reconcile both the steep price increases and high launch prices.
590 $a School code: 0084.
650 4 $a Health care management. $3 2122906
650 4 $a Teaching. $3 517098
650 4 $a Reimbursement. $3 3680791
650 4 $a Health care policy. $3 3550686
650 4 $a Government purchasing. $3 726071
650 4 $a Values. $3 518648
650 4 $a Hospitals. $3 616081
650 4 $a Rehabilitation. $3 529790
650 4 $a Health care expenditures. $3 3433801
650 4 $a Physical therapy. $3 588713
650 4 $a Feedback. $3 677181
650 4 $a Chronic obstructive pulmonary disease. $3 3558078
650 4 $a Patients. $3 1961957
650 4 $a Aging. $3 543123
650 4 $a Decision making. $3 517204
650 4 $a Altruism. $3 630284
650 4 $a Monetary incentives. $3 3685880
653 $a Contracting
653 $a Healthcare
653 $a Provider payment
653 $a Incentives
653 $a Medicare
690 $a 0501
690 $a 0769
690 $a 0493
690 $a 0382
710 2 $a Harvard University. $b Economics. $3 2049893
773 0 $t Dissertations Abstracts International $g 83-02B.
790 $a 0084
791 $a Ph.D.
792 $a 2021
793 $a English
856 4 0 $u http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=28499241