Performance Indicators for Quality with Adverse Selection, Gaming and Inequality Aversion
University of Rostock
University of York
CEPR Discussion Paper No. DP6261
Performance indicators are increasingly used to regulate quality in health care and other areas of the public sector. We develop a model of contracting between a purchaser (principal) and a provider (agent) under the following scenarios: a) higher ability increases quality directly and indirectly (through a lower marginal cost of quality); b) the provider can game the system (or misreport); c) the purchaser is averse to inequality. The main results are: 1) if ability has a direct impact on quality, quality effort is lower and distortions from informational rents are higher; under some conditions more able providers exert lower quality effort; 2) gaming or misreporting reduces the optimal level of quality effort but generally increases the level of quality targets (and measured quality). Pooling may be optimal for high types (or all types) if the benefit function is sufficiently concave and the cost of manipulation is at intermediate levels; 3) If patients receive a low benefit from health care because quality is low then higher inequality aversion increases the optimal level of quality and the associated transfer, and reduces quality dispersion.
Number of Pages in PDF File: 41
Keywords: adverse selection, falsification, inequality aversion, moral hazard, performance, quality
JEL Classification: D82, I11, I18, L51working papers series
Date posted: May 21, 2008
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