Adjudication

A short (about 1,000 words) overview of adjudication, describing the standard view (judges should just apply the law, when possible) and two goal-oriented views: wealth maximization and the maximization of well-being – i.e., utilitarian adjudication

Act Utilitarianism

An overview (about 8,000 words) of act utilitarianism, covering the basic idea of the theory, historical examples, how it differs from rule utilitarianism and motive utilitarianism, supporting arguments, and standard objections. A closing section provides a brief introduction to indirect utilitarianism (i.e., a Hare- or Railton-style view distinguishing between a decision procedure and a criterion of rightness)

Multitasking, Competition and Provider Payment

Many important dimensions of quality health care are difficult to observe, monitor, and motivate. This paper examines how competition among providers interacts with payment system incentives when the allocation of provider effort among multiple such dimensions or ‘tasks’ is noncontractible. The framework highlights that an optimal provider payment system, including optimal risk adjustment, should take account of provider multitasking.payment incentives, competition, multitasking, capitation, managed care, rationing, risk adjustment

Introduction

The introduction (about 6,000 words) to _The Cambridge Companion to Utilitarianism_, in three sections: utilitarianism’s place in recent and contemporary moral philosophy (including the opinions of critics such as Rawls and Scanlon), a brief history of the view (again, including the opinions of critics, such as Marx and Nietzsche), and an overview of the chapters of the book

Physician Dual Practice: Access Enhancement or Demand Inducement?

In many developing countries, the majority of physicians employed in government clinics also have a private practice. We develop a simple model to show that allowing dual practice helps low-income governments retain skilled physicians to assure patient access. If dual-practice providers differentially refer higher-income patients to private practice, public funding becomes more effectively targeted on the poor. Yet dual practice physicians may also skimp on effort, pilfer supplies, and induce demand. Patterns of care-seeking in Indonesia, especially disproportionate use of private providers by the urban poor, are consistent with exacerbated incentive for physician self-referral to private practice in urban areas.

Measuring Selection Incentives in Managed Care: Evidence from the Massachusetts State Employee Insurance Program

Health economists and policymakers have long recognized that capitation gives insurers incentive to manipulate their offerings to deter the sick and attract the healthy. The shadow-price ap- proach to measuring such selection incentives was pioneered by Frank, Glazer and McGuire (2000). We extend their model to allow for partial capitation and nonfinancial concerns of insurers. We calculate three kinds of selection metrics using managed care medical and pharmacy spending data for fiscal years 2001 and 2002 from the Massachusetts state employee insurance program. Financial returns to risk selection are high, as indicated by all three selection indices as well as by the direct profits an insurer could earn if it could exclude unprofitable patients. Empirically, the financial temptation to distort service quality increases non- linearly with supply-side cost sharing. The more an insurer di- rectly values quality or patient benefit relative to profit, the less severe risk selection incentives become.risk selection; managed health care; shadow price; mixed payment

Hospital Competition under Regulated Prices: Application to Urban Health Sector Reforms in China

We develop a model of public-private hospital competition un- der regulated prices, recognizing that hospitals are multi-service Þrms and that equilibria depend on the interactions of patients, hospital administrators, and physicians. We then use data from China to calibrate a simulation model of the impact of China?s recent payment and organizational reforms on cost, quality and access. Both the analytic and simulation results show how provid- ing implicit insurance through distorted prices leads to over/under use of services by proÞtability, which in turn fuels cost escalation and reduces access for those who cannot a?ord to self-pay for care. Hospital competition for patients will improve social welfare only if policymakers pay careful attention to payment incentives and regulation.

Subprime outcomes: turmoil in the mortgage market

Until 2007, few Americans had probably heard the word “subprime” - including many homeowners who would come to learn that their own mortgage was a subprime mortgage. Today, subprime mortgages are much discussed because they lie at the center of the turmoil that roiled credit markets in 2007 and 2008.Subprime mortgage

Health Care Payment Incentives: A Comparative Analysis of Reforms in Taiwan, Korea and China

Payment incentives have significant consequences for the equity and efficiency of a health care system, and have recently come to the fore in health policy reforms. This paper first discusses the economic rationale for apparent international convergence toward payment systems with mixed demand and supplyside cost sharing. We then summarize the recent payment reforms undertaken in Taiwan, Korea and China. Available evidence clearly indicates that incentives matter, and that supply-side cost sharing in particular can improve efficiency without undermining equity. Further study and monitoring of quality and selection is warranted.