An economic analysis of payment for health care services: The United States and Switzerland compared

This article seeks to assess whether physician payment reforms in the United States and Switzerland were likely to attain their objectives. We first introduce basic contract theory, with the organizing principle being the degree of information asymmetry between the patient and the health care provider. Depending on the degree of information asymmetry, different forms of payment induce "appropriate” behavior. These theoretical results are then pitted against the RBRVS of the United States to find that a number of its aspects are not optimal. We then turn to Switzerland's Tarmed and find that it fails to conform with the prescriptions of economic contract theory as well. The article closes with a review of possible reforms that could do away with uniform fee schedules to improve the performance of the health care syste

Efficient Delegation by an Informed Principal

Consider the case of a firm with private valuation information bargaining with a supplier over the price and quantity of a good. If the firm and the supplier bargain directly, the bargaining outcome may not yield a first-best outcome due to the presence of information rents. The question we examine in this paper is whether these direct bargaining inefficiencies can be eliminated if the firm delegates the authority to negotiate with the supplier to an agent. We model the agent as an independent profit center that contracts with the parent firm as well as the supplier. The delegation of decision-making to the agent can influence the interaction between the firm and the supplier by altering the information rents the agent can claim from the supplier. To identify the role of delegation, we focus instead on two games. Both games have a continuum of equilibria, which we compare to the set of incentive efficient equilibria of the initial no-delegation bargaining game. The first game involves partial delegation as the firm controls the release of its private information through a public transfer price charged to the agent. Because the relationship between the agent and the uninformed supplier is one of full information, the unique equilibrium quantity is first-best yet we show that the informed firm still earns an information rent. The second game involves full delegation as the agent controls both the quantity choice and the release of the firm's private information. We show that the full delegation game has a large set of equilibria that includes all of the incentive efficient equilibria of the bargaining game as well as inefficient equilibria. We believe our notion of partial delegation can be reflected in firms organized as profit centers and the management practice of category managementDelegation, common agency

A comparison of responses to single and repeated discrete choice questions

According to neoclassical economic theory, a stated preference elicitation format comprising a single binary choice between the status quo and one alternative is incentive compatible under certain conditions. Formats typically used in choice experiments comprising a sequence of discrete choice questions do not hold this property. In this paper, the effect on stated preferences of expanding the number of binary choice tasks per respondent from one to four is tested using a split sample treatment in an attribute-based survey relating to the undergrounding of overhead electricity and telecommunications wires. We find evidence to suggest that presenting multiple choice tasks per respondent decreases estimates of expected willingness to pay. Preferences stated in the first of a sequence of choice tasks are not significantly different from those stated in the incentive compatible single binary choice task, but, in subsequent choice tasks, responses are influenced by cost levels observed in past questions. Three behavioural explanations can be advanced – weak strategic misrepresentation, reference point revision and cost-driven value learning. The evidence is contrary to the standard assumption of truthful response with stable preferences.Choice experiment; willingness-to-pay; incentive compatibility; order effects; undergrounding

Strategic response to a sequence of discrete choice questions

According to neoclassical economic theory, the only stated preference elicitation format that can feasibly be employed in field studies to which truthful response can be the dominant strategy for all respondents is a single binary choice between the status quo and one alternative. In studies where the objective is estimation of preferences for multiple attributes of a good, it is preferred (and, in some cases, necessary) based on econometric considerations, to present respondents with a sequence of choice tasks. Economic theory predicts that utility-maximising respondents may find it optimal to misrepresent their preferences in this elicitation format. In this paper, the effect on stated preferences of expanding the number of choice tasks per respondent from one to four is tested using a split sample treatment in an attribute-based survey relating to the undergrounding of overhead electricity and telecommunications wires in the Australian Capital Territory. We find evidence to suggest that presenting multiple choice tasks per respondent decreases estimates of total willingness to pay and that this effect is related to the ordering of cost levels presented over the sequence of choice tasks. Two behavioural explanations can be advanced - a weak cost minimisation strategy, which implies divergence between stated and true preferences, and a ‘good deal / bad deal’ heuristic, in which stated preferences reflect true preferences that change over the course of the sequence of choice tasks. Preferences stated in the first of a sequence of choice tasks are not significantly different from those stated in the incentive compatible single binary choice task. A key objective of future research will be to establish whether this effect becomes less prevalent as the number of attributes and alternatives per choice task are increased.Choice experiments, willingness to pay, incentive compatibility, strategic behaviour, order effects, underground electricity, Research Methods/ Statistical Methods,

Algorithmic Bayesian Persuasion

Persuasion, defined as the act of exploiting an informational advantage in order to effect the decisions of others, is ubiquitous. Indeed, persuasive communication has been estimated to account for almost a third of all economic activity in the US. This paper examines persuasion through a computational lens, focusing on what is perhaps the most basic and fundamental model in this space: the celebrated Bayesian persuasion model of Kamenica and Gentzkow. Here there are two players, a sender and a receiver. The receiver must take one of a number of actions with a-priori unknown payoff, and the sender has access to additional information regarding the payoffs. The sender can commit to revealing a noisy signal regarding the realization of the payoffs of various actions, and would like to do so as to maximize her own payoff assuming a perfectly rational receiver. We examine the sender's optimization task in three of the most natural input models for this problem, and essentially pin down its computational complexity in each. When the payoff distributions of the different actions are i.i.d. and given explicitly, we exhibit a polynomial-time (exact) algorithm, and a "simple" $(1-1/e)$-approximation algorithm. Our optimal scheme for the i.i.d. setting involves an analogy to auction theory, and makes use of Border's characterization of the space of reduced-forms for single-item auctions. When action payoffs are independent but non-identical with marginal distributions given explicitly, we show that it is #P-hard to compute the optimal expected sender utility. Finally, we consider a general (possibly correlated) joint distribution of action payoffs presented by a black box sampling oracle, and exhibit a fully polynomial-time approximation scheme (FPTAS) with a bi-criteria guarantee. We show that this result is the best possible in the black-box model for information-theoretic reasons

Entry Costs, Intermediation, and Capital Flows

In this paper, we reexamine the question "Why doesn't capital flow from rich to poor countries?" posed, most recently, by Lucas (1990). We build a simple contracting framework where costly intermediation together with an adverse selection problem have quantitatively important effects on capital flows. When intermediation costs are ignored, the model behaves much like the neoclassical model in terms of capital returns. However, when intermediation costs are considered, the return for a given amount of capital can be non-monotonic in costs. Therefore, the combination of capital and cost differences across countries gives rise to a rich variation of returns, one that suggests a tendency for capital to flow to middle income countries, as seen in data. Indeed, when we embed the static return function in a two-country dynamic model, there is capital outflow from a poor country that removes capital controls and becomes open. We find that even though the closed economy dominates in terms of capital employed in production, it is the open economy that dominates in terms of income, consumption and welfare.Capital flows, Financial intermediation

Information Sharing and Cross-border Entry in European Banking

Information asymmetries can severely limit cross-border border expansion of banks. When a bank enters a new market, it has incomplete information about potential new clients. Such asymmetries are reduced by credit registers, which distribute financial data on bank clients. We investigate the interaction of credit registers and bank entry modes (in form of branching and M&A) by using a new set of time series cross-section data for the EU-27 countries. We study how the presence of public and private credit registers and the type of information exchanged affect bank entry modes during the period 1990-2007. Our analysis shows that the existence of both types of registers increases the share of branching in the overall entries. Additionally, the establishment of public registers reduces concentration ratios, and some banking competition indicators (such as overhead costs/assets). The introduction of a private credit bureau, on the other hand, has no effect on concentration ratios, but positively contributes to competition (by decreasing interest rate margins). This suggests that credit registers facilitate direct entry through a reduction of information asymmetries, which in turn intensifies competition.credit registries, foreign entry, asymmetric information