Sorting into payment schemes and medical treatment: A laboratory experiment

Brosig-Koch, Jeannette; Kairies-Schwarz, Nadja; Kokot, Johanna

doi:10.1002/hec.3616

Cited by 10 publications

(5 citation statements)

References 38 publications

(53 reference statements)

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“…This result is consistent with the findings of Brosig‐Koch et al. (2017) and shows that changing the pricing format can be effective in improving patient treatment. However, although we provide some elements justifying the effectiveness of OPTAM, it should be kept in mind that opting in to OPTAM is not necessarily exogenous.…”

Section: Discussionsupporting

confidence: 92%

“…We show that the penalty for CMU-C and ACS is higher for unregulated physicians than regulated physicians and that signing OPTAM reduces it: OPTAM offsets 65% and 81% of the penalty that unregulated physicians apply to CMU-C and ACS patients, respectively. This result is consistent with the findings of Brosig-Koch et al (2017) and shows that changing the pricing format can be effective in improving patient treatment. However, although we provide some elements justifying the effectiveness of OPTAM, it should be kept in mind that opting in to OPTAM is not necessarily exogenous.…”

Section: Discussionsupporting

confidence: 91%

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Cream skimming and discrimination in access to medical care: A field experiment

2023

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This study measures the differences in access to healthcare for female patients in France in three medical specialties (dentistry, gynecology and psychiatry) according to two criteria: the African ethnicity of the patient and the benefit of having means‐tested health insurance coverage. To this purpose, we conducted a nationally representative field experiment on more than 1500 physicians. We do not find substantial discrimination against the patient of African origin. However, the results indicate that patients with means‐tested health insurance coverage are less likely to get an appointment. Differentiating between two types of coverage, we show that the lesser‐known coverage (ACS) is more penalized than the other (CMU‐C) as poor knowledge of the program increases the physician's expectation of additional administrative tasks and is an important element to explain cream‐skimming. We also find that, for physicians who are free to set their fees, the opportunity cost of accepting a means‐tested patient increases the penalty. Finally, the results suggest that enrollment in OPTAM, the controlled pricing practice option that incentivizes physicians to accept means‐tested patients, reduces cream‐skimming.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 91%

Cream skimming and discrimination in access to medical care: A field experiment

2023

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“…Theoretical and empirical evidence on the relationship between physician remuneration and quality of medical care suggests that capitation entails an incentive for underprovision, while fee‐for‐service can induce overprovision (see, e.g., Ding & Liu, 2021; Ellis & McGuire, 1986; Gaynor & Gertler, 1995; Gosden et al., 2000; Gravelle & Masiero, 2000; Patcharanarumol et al., 2018). Experimental research provides similar evidence (e.g., Brosig‐Koch et al., 2016, Brosig‐Koch, Hennig‐Schmidt, et al., 2017; Brosig‐Koch, Kairies‐Schwarz, et al., 2017; Di Guida et al., 2019; Green, 2014; Hennig‐Schmidt et al., 2011; Lagarde & Blaauw, 2017; Martinsson & Persson, 2019; Reif et al., 2020).…”

Section: Related Literaturementioning

confidence: 68%

Who benefits from quality competition in health care? A theory and a laboratory experiment on the relevance of patient characteristics

Brosig-Koch

Hehenkamp

Kokot³

2023

Health Economics

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We study how competition between physicians affects the provision of medical care. In our theoretical model, physicians are faced with a heterogeneous patient population, in which patients systematically vary with regard to both their responsiveness to the provided quality of care and their state of health. We test the behavioral predictions derived from this model in a controlled laboratory experiment. In line with the model, we observe that competition significantly improves patient benefits as long as patients are able to respond to the quality provided. For those patients, who are not able to choose a physician, competition even decreases the patient benefit compared to a situation without competition. This decrease is in contrast to our theoretical prediction implying no change in benefits for passive patients. Deviations from patient‐optimal treatment are highest for passive patients in need of a low quantity of medical services. With repetition, both, the positive effects of competition for active patients as well as the negative effects of competition for passive patients become more pronounced. Our results imply that competition can not only improve but also worsen patient outcome and that patients' responsiveness to quality is decisive.

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“…What is the role, for example, of individuals' underlying social preferences, attitudes or personality traits? These individual characteristics might not only explain health care workers' responses to performance pay (e.g., Donato et al, 2017) but also self-selection into payment systems (e.g., Dohmen and Falk, 2011;Brosig-Koch et al, 2017b). Understanding the preferences that predict sorting are therefore of great importance for researchers and health care policy-makers alike.…”

Section: Discussionmentioning

confidence: 99%