Outcomes-Based Reimbursement Policies for Chronic Care Pathways
52 Pages Posted: 24 May 2017
Date Written: May 24, 2017
We consider contracting issues in the care of patients with chronic conditions within the principal-agent framework. The government, acting as a principal, contracts with several health care providers in an effort to maximise population health minus the cost. We consider the decision of whether to contract with individual health care providers or groups of such providers, as well as which contract type to use. We show that the first best outcome can be achieved by both individual and group contracts through the use of either outcomes-adjusted capitation or outcomes-adjusted per-patient contracts. We also examine possible issues which can arise as the entities that are contracted with are not necessarily the ones making decisions about patient care. Individual contracts can fail to provide the desired incentives if providers under such contracts jointly make decisions about the care for their patients (collusion); however, so can group contracts if the group members fail to coordinate their actions (free-riding). We show that both of those result in potential deviations from optimal decisions, with direction and magnitude of deviation depending on the contract type held. We conduct numerical experiments calibrated using data from United Kingdom's NHS and demonstrate that individual outcomes-adjusted capitation contracts are the most robust to these adverse effects.
Keywords: Health Care, Contracting, Moral Hazard, Queue, Outcomes, Value Based, Collusion, Free riding
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