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Optimal Contracting with Altruistic Agents: A Structural Model of Medicare Payments for Dialysis Drugs 利他主体的最优契约:透析药物医疗保险支付的结构模型
PSN: Health Care Delivery (Topic) Pub Date : 2020-05-01 DOI: 10.3386/w27172
M. Gaynor, N. Mehta, Seth Richards-Shubik
{"title":"Optimal Contracting with Altruistic Agents: A Structural Model of Medicare Payments for Dialysis Drugs","authors":"M. Gaynor, N. Mehta, Seth Richards-Shubik","doi":"10.3386/w27172","DOIUrl":"https://doi.org/10.3386/w27172","url":null,"abstract":"We study physician agency and optimal payment policy in the context of an expensive medication used in dialysis care. Using Medicare claims data we estimate a structural model of treatment decisions, in which physicians differ in their altruism and marginal costs, and this heterogeneity is unobservable to the government. In a novel application of nonlinear pricing methods, we theoretically characterize the optimal unrestricted contract in this screening environment with multidimensional heterogeneity. We combine these results with the estimated model to construct the optimal contract and simulate counterfactual outcomes. The optimal contract is a flexible fee-for-service contract, which pays for reported treatments but uses variable marginal payments instead of constant reimbursement rates, resulting in substantial health improvements and reductions in costs. Our structural approach also yields important qualitative findings, such as rejecting the optimality of any linear contract, and may be employed more broadly to analyze a variety of applications.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"135 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127349973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Effects of the Covid-19 Pandemic on Outpatient Providers in the Us Covid-19大流行对美国门诊服务提供者的影响
PSN: Health Care Delivery (Topic) Pub Date : 2020-05-01 DOI: 10.3386/w27173
Pinka Chatterji, Yue Li
{"title":"Effects of the Covid-19 Pandemic on Outpatient Providers in the Us","authors":"Pinka Chatterji, Yue Li","doi":"10.3386/w27173","DOIUrl":"https://doi.org/10.3386/w27173","url":null,"abstract":"There is growing concern that the COVID-19 pandemic may have severe, adverse effects on the health care sector, a sector of the economy that historically has been somewhat shielded from the business cycle. In this paper, we study one aspect of this issue by estimating the magnitude of the COVID-19 pandemic on use of outpatient health services. We use 2010-2020 data from the Outpatient Influenza-like Illness Surveillance Network (ILINet). Our findings indicate that the COVID-19 pandemic is associated with about a 67 percent decline in the total number of outpatient visits per provider by the week of April 12-18th, 2020 relative to the same week in prior years. Effects become apparent earlier in the pandemic for outpatient visits for non-flu symptoms, but we find negative effects on outpatient visits for flu symptoms as well.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129606892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 21
Aggregated Smartphone Location Data to Assist in Response to Pandemic 汇总智能手机位置数据以协助应对流行病
PSN: Health Care Delivery (Topic) Pub Date : 2020-04-02 DOI: 10.2139/ssrn.3570744
B. Skorup, Teresa Mitchell
{"title":"Aggregated Smartphone Location Data to Assist in Response to Pandemic","authors":"B. Skorup, Teresa Mitchell","doi":"10.2139/ssrn.3570744","DOIUrl":"https://doi.org/10.2139/ssrn.3570744","url":null,"abstract":"The sudden, mandated closures of businesses, restaurants, and schools in response to the COVID-19 pandemic impose severe economic and social costs People want","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121600960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 6
Containing the Virus or Reviving the Economy? Evidence from Individual Expectations during the COVID-19 Epidemic 遏制病毒还是重振经济?来自COVID-19流行期间个人期望的证据
PSN: Health Care Delivery (Topic) Pub Date : 2020-03-29 DOI: 10.1257/rct.5618-1.1
Keyang Li, Yu Qin, Jing Wu, Jubo Yan
{"title":"Containing the Virus or Reviving the Economy? Evidence from Individual Expectations during the COVID-19 Epidemic","authors":"Keyang Li, Yu Qin, Jing Wu, Jubo Yan","doi":"10.1257/rct.5618-1.1","DOIUrl":"https://doi.org/10.1257/rct.5618-1.1","url":null,"abstract":"How does an epidemic affect individuals’ expectations on economic prospects? Do people care more about containing the disease or sustaining normal economic activities during the epidemic? We implement an incentivized longitudinal online survey on economic expectations with randomized controlled trials during the COVID-19 epidemic in China to answer these questions. Conditioning on individual fixed effects, we find that lower number of confirmed COVID-19 cases in a city significantly increases individual’s expectation on GDP growth rate. However, individuals’ perception on the level of economic recovery is not correlated with their expectations on GDP growth. Moreover, individuals do not update their expectations when information on work resumption rate is provided in a randomized controlled trial. Our finding conveys the message to policy makers that, during an epidemic, containing the spread of the disease should be prioritized than resuming economic activities, at least from the perspective of maintaining positive economic expectations among individuals.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117117238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 16
Data Gaps and the Policy Response to the Novel Coronavirus 数据缺口和应对新型冠状病毒的政策
PSN: Health Care Delivery (Topic) Pub Date : 2020-03-01 DOI: 10.3386/w26902
J. Stock
{"title":"Data Gaps and the Policy Response to the Novel Coronavirus","authors":"J. Stock","doi":"10.3386/w26902","DOIUrl":"https://doi.org/10.3386/w26902","url":null,"abstract":"This note lays out the basic Susceptible-Infected-Recovered (SIR) epidemiological model of contagion, with a target audience of economists who want a framework for understanding the effects of social distancing and containment policies on the evolution of contagion and interactions with the economy. A key parameter, the asymptomatic rate (the fraction of the infected that are not tested under current guidelines), is not well estimated in the literature because tests for the coronavirus have been targeted at the sick and vulnerable, however it could be estimated by random sampling of the population. In this simple model, different policies that yield the same transmission rate β have the same health outcomes but can have very different economic costs. Thus, one way to frame the economics of shutdown policy is as finding the most efficient policies to achieve a given β, then determining the path of β that trades off the economic cost against the cost of excess lives lost by overwhelming the health care system.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129233329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 175
Public Financial Management Perspectives on Health Sector Financing and Resource Allocation in Ethiopia 从公共财政管理的角度看埃塞俄比亚卫生部门融资和资源分配
PSN: Health Care Delivery (Topic) Pub Date : 2020-02-07 DOI: 10.2139/ssrn.3534342
R. Kelly, R. Hemming, Ipchita Bharali, Graham Glenday, A. Asfaw
{"title":"Public Financial Management Perspectives on Health Sector Financing and Resource Allocation in Ethiopia","authors":"R. Kelly, R. Hemming, Ipchita Bharali, Graham Glenday, A. Asfaw","doi":"10.2139/ssrn.3534342","DOIUrl":"https://doi.org/10.2139/ssrn.3534342","url":null,"abstract":"In this paper, we discuss Ethiopia’s approach to health delivery, trends in health financing trends, focusing on the financing arrangements and expenditure management systems through which health funding is allocated from various internal and external sources. The paper reviews Ethiopia’s public financial management system to identify challenges and opportunities to improve domestic resource mobilization for health and resource allocation within the health sector. With the imminent transition away from external donor support that Ethiopia faces due to economic growth, the paper explores the sources of fiscal space for health in Ethiopia to sustain progress in the health sector through a deep dive of the sources of health financing through tax and non-tax revenues, additional borrowing, future aid prospects, and better fiscal discipline and expenditure efficiency.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"475 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116521422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
Анализ практики и перспектив оказания медицинской помощи с применением телемедицинских технологий (Analysis of the Practice and Prospects of Providing Medical Care Using Telemedicine Technologies)
PSN: Health Care Delivery (Topic) Pub Date : 2020-01-30 DOI: 10.2139/ssrn.3540076
S. Kovalev, E. Yashina, Konstantin Lukichev, P. Sorokoletov, P. Turzin, A. Generalov, A. Evseev, Artem Knutov
{"title":"Анализ практики и перспектив оказания медицинской помощи с применением телемедицинских технологий (Analysis of the Practice and Prospects of Providing Medical Care Using Telemedicine Technologies)","authors":"S. Kovalev, E. Yashina, Konstantin Lukichev, P. Sorokoletov, P. Turzin, A. Generalov, A. Evseev, Artem Knutov","doi":"10.2139/ssrn.3540076","DOIUrl":"https://doi.org/10.2139/ssrn.3540076","url":null,"abstract":"<b>Russian Abstract:</b> Осуществлен анализ факторов, влияющих на качество и сроки внедрения федеральной телемедицинской подсистемы Единой государственной информационной системы в сфере здравоохранения, а также рассмотрен механизм её функционирования. Помимо этого, выявлено соответствие целей и задач концепции создания и развития телемедицинской подсистемы ЕГИСЗ на период до 2020 года, с учетом региональной специфики и потребностей приоритетного проекта «Совершенствование процессов организации медицинской помощи на основе внедрения информационных технологий» (Электронное здравоохранение), и Стратегии развития информационного общества в Российской Федерации на 2017 - 2030 годы.<br><br><b>English Abstract:</b> The analysis of factors affecting the quality and timing of the implementation of the federal telemedicine subsystem of the Unified State Information System in the field of healthcare was carried out, and the mechanism of its functioning was considered. In addition, the compliance of goals and objectives with the concept of creating and developing the telemedicine subsystem of the EHISS for the period up to 2020 was revealed, taking into account the regional specifics and needs of the priority project “Improving the organization of medical care through the implementation of information technologies” (e-Health), and the Information Development Strategy societies in the Russian Federation for 2017 - 2030.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116959590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Quality Improvement Spillovers: Evidence From the Hospital Readmissions Reduction Program 质量改进的溢出效应:来自医院再入院减少计划的证据
PSN: Health Care Delivery (Topic) Pub Date : 2020-01-17 DOI: 10.2139/ssrn.3132770
Mohamad Soltani, R. Batt, Hessam Bavafa
{"title":"Quality Improvement Spillovers: Evidence From the Hospital Readmissions Reduction Program","authors":"Mohamad Soltani, R. Batt, Hessam Bavafa","doi":"10.2139/ssrn.3132770","DOIUrl":"https://doi.org/10.2139/ssrn.3132770","url":null,"abstract":"Financial incentives are commonly used to encourage improvements in quality. However, the presence of spillovers can make managing these incentives difficult. Using a large, national dataset, we study the spillover effects of a national healthcare quality improvement policy, the Hospital Readmissions Reduction Program (HRRP), on patients and metrics not targeted by the policy. Whereas prior work has shown limited spillover of quality improvement initiatives in manufacturing settings, we find that in the healthcare setting HRRP led to improvements of 3% to 6% in 30-day readmissions (the target metric) for those targeted by the policy as well as for those with non-targeted insurance types or clinical conditions. We also find significant improvements in non-targeted measures such as 31-60-day readmissions and hospitalization cost. These findings provide insight into how hospitals operationalized quality improvements, as the legislation had beneficial spillover effects beyond the narrow focus of the policy.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"96 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116535818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 20
Perceptual Bias and Public Programs: The Case of the United States and Hospital Care 感性偏见和公共项目:美国和医院护理的案例
PSN: Health Care Delivery (Topic) Pub Date : 2019-11-01 DOI: 10.1111/PUAR.13067
K. Meier, Austin P. Johnson, Seung‐Ho An
{"title":"Perceptual Bias and Public Programs: The Case of the United States and Hospital Care","authors":"K. Meier, Austin P. Johnson, Seung‐Ho An","doi":"10.1111/PUAR.13067","DOIUrl":"https://doi.org/10.1111/PUAR.13067","url":null,"abstract":"This article examines whether the public holds biased perceptions of public organizations (in this case, hospitals) in the United States and whether organizations get credit for positive results from program evaluations. Using an experimental design that replicates Hvidman and Andersen's 2016 Danish study, the study finds no negative public sector biases in the United States, but organizations are not given any credit for positive program evaluations. These results hold in two experimental replications. The implications of the findings for the measurement of public perceptions of government programs and for effective democratic governance are discussed.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"122 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126723475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 27
Selection with Variation in Diagnostic Skill: Evidence from Radiologists 诊断技能变化的选择:来自放射科医生的证据
PSN: Health Care Delivery (Topic) Pub Date : 2019-11-01 DOI: 10.3386/w26467
David C. Chan, M. Gentzkow, Chuan Yu
{"title":"Selection with Variation in Diagnostic Skill: Evidence from Radiologists","authors":"David C. Chan, M. Gentzkow, Chuan Yu","doi":"10.3386/w26467","DOIUrl":"https://doi.org/10.3386/w26467","url":null,"abstract":"Physicians, judges, teachers, and agents in many other settings differ systematically in the decisions they make when faced with similar cases. Standard approaches to interpreting and exploiting such differences assume they arise solely from variation in preferences. We develop an alternative framework that allows variation in preferences and diagnostic skill and show that both dimensions may be partially identified in standard settings under quasi-random assignment. We apply this framework to study pneumonia diagnoses by radiologists. Diagnosis rates vary widely among radiologists, and descriptive evidence suggests that a large component of this variation is due to differences in diagnostic skill. Our estimated model suggests that radiologists view failing to diagnose a patient with pneumonia as more costly than incorrectly diagnosing one without, and that this leads less skilled radiologists to optimally choose lower diagnostic thresholds. Variation in skill can explain 39% of the variation in diagnostic decisions, and policies that improve skill perform better than uniform decision guidelines. Failing to account for skill variation can lead to highly misleading results in research designs that use agent assignments as instruments.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131759667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 55
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