ECON 440 Lecture 21: Lecture 21 - Organization of Health Care Service Delivery Principles and Impacts
13 Jun 2018
School
Department
Course
Professor
OH: 4 - 5pm
5 questions with subparts
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Final
Not new - but has changed the landscape of delivery and insurance of healthcare in the US
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Managed care
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More new, under the ACA
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Accountable care organizations
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New over the last decade - prevalent in the Canadian and US discussion
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How are primary care services delivered?
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How are primary care givers organized?
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Integrated primary care teams and medical homes
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Models for health care services delivery:
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Why these innovations?
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What tools do they use?
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How do each of these innovations affect the principal-agent relationships in health care?
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How does each address the major tradeoffs identified by health economics?
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Discussion
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Outline
Payers, patients, providers, etc.
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Multiple principal-agent relationships
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e.g. there are self-employed physicians, some aren't paid by the same insurers as others -
there are many independent entities (including patients producing their own health)
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Nor are they necessarily cohesive
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Most don't have incentives to produce efficiently in their own realm, let alone efficient production
in the population as a whole
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Many separate healthcare providers, none with the financial incentive to produce efficiently
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Patients have incentives to over-use care if they're insured
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The healthcare system's goal is to provide high-quality care to a patient population, and improve health,
efficiently
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Everyone is working in odds rather than towards a shared goal
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How can we use financial and other incentives to get there?
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Aligning Incentives in Health Care
Quantity/type/quality
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A range of tools exist to help move the health care system toward using the "optimal" mix of services
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We want some demand-side cost-sharing
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Given the moral hazard vs. risk spreading tradeoff, neither full insurance nor no insurance is
optimal
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We want some supply-side cost-sharing
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Given the adverse selection vs. efficiency tradeoff, neither full nor no supplier cost-sharing is
optimal
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The two fundamental trade-offs and cost-sharing
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Supply-side affects intensity once treatment has been sought
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Demand-side cost sharing affects decision to seek care
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Supply-side puts financial risk on providers
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Demand-side puts financial risk on patients
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Conclusions on Financial Incentives
Align incentives among (former) principals and agents
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Integrated Delivery Systems
Lecture 21 - Organization of Health Care Service Delivery:
Principles and Impacts
Wednesday, March 28, 2018
10:07 AM
ECON 440 Page 1
Document Summary
Lecture 21 - organization of health care service delivery: Not new - but has changed the landscape of delivery and insurance of healthcare in the us. New over the last decade - prevalent in the canadian and us discussion. Many separate healthcare providers, none with the financial incentive to produce efficiently. Nor are they necessarily cohesive e. g. there are self-employed physicians, some aren"t paid by the same insurers as others - there are many independent entities (including patients producing their own health) Most don"t have incentives to produce efficiently in their own realm, let alone efficient production in the population as a whole. Patients have incentives to over-use care if they"re insured. The healthcare system"s goal is to provide high-quality care to a patient population, and improve health, efficiently. Everyone is working in odds rather than towards a shared goal. A range of tools exist to help move the health care system toward using the optimal mix of services.
