Multiple Payers in Health Care : A Framework for Assessment

The starting point of the debate about the pros and cons of multipayer systems is the suspicion that in many health care systems, consumers do not get sufficient value for money. This contribution argues that one cause may be a non-optimal choice o...

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Main Author:	Zweifel, Peter
Format:	Working Paper
Language:	English en_US
Published:	World Bank, Washington, DC 2013
Subjects:	ACCESS TO HEALTH CARE AGED AGENTS AGING BEDS CAPITATION CONSUMERS CREAM SKIMMING DISCRIMINATION HEALTH CARE HEALTH CARE FINANCE HEALTH CARE FINANCING HEALTH CARE PROVIDER HEALTH CARE PROVIDERS HEALTH CARE SECTOR HEALTH CARE SERVICES HEALTH CARE SYSTEMS HEALTH CONDITIONS HEALTH INSURANCE HEALTH INSURERS HEALTH MAINTENANCE ORGANIZATIONS HEALTH OUTCOMES HEALTH RISKS HEALTH SECTOR HEALTH SERVICES HEALTH STATUS HEALTH SYSTEM HEART SURGERY HOSPITAL ADMISSION HOSPITALS HUMAN DEVELOPMENT HUMAN RESOURCES INCOME INTERVENTION LATIN AMERICAN LESSONS LEARNED LOW-INCOME COUNTRIES MANAGED CARE MARGINAL COST MEDICAID MEDICAL ASSOCIATIONS MEDICAL CARE MEDICAL EQUIPMENT MEDICAL SERVICES MEDICAL TECHNOLOGY MEDICAL TREATMENT MEDICARE MOTIVATION NATIONAL HEALTH INSURANCE NUTRITION PATIENTS PHYSICIANS PREMIUMS PRIVATE INSURANCE PROBABILITY PROFESSIONAL ASSOCIATIONS PROGRAMS PROMOTING HEALTH PROVIDER INCENTIVES PUBLIC HEALTH PUBLIC HEALTH CARE PUBLIC SECTOR RATES RISK AVERSION SAVINGS SERVICE DELIVERY SOCIAL INSURANCE SOCIAL SECURITY THAILAND WEIGHT WORKERS
Online Access:	http://documents.worldbank.org/curated/en/2004/09/5643877/multiple-payers-health-care-framework-assessment http://hdl.handle.net/10986/13704

id	okr-10986-13704
recordtype	oai_dc
spelling	okr-10986-137042021-04-23T14:03:09Z Multiple Payers in Health Care : A Framework for Assessment Zweifel, Peter ACCESS TO HEALTH CARE AGED AGENTS AGING BEDS CAPITATION CONSUMERS CREAM SKIMMING DISCRIMINATION HEALTH CARE HEALTH CARE FINANCE HEALTH CARE FINANCING HEALTH CARE PROVIDER HEALTH CARE PROVIDERS HEALTH CARE SECTOR HEALTH CARE SERVICES HEALTH CARE SYSTEMS HEALTH CONDITIONS HEALTH INSURANCE HEALTH INSURERS HEALTH MAINTENANCE ORGANIZATIONS HEALTH OUTCOMES HEALTH RISKS HEALTH SECTOR HEALTH SERVICES HEALTH STATUS HEALTH SYSTEM HEART SURGERY HOSPITAL ADMISSION HOSPITALS HUMAN DEVELOPMENT HUMAN RESOURCES INCOME INTERVENTION LATIN AMERICAN LESSONS LEARNED LOW-INCOME COUNTRIES MANAGED CARE MARGINAL COST MEDICAID MEDICAL ASSOCIATIONS MEDICAL CARE MEDICAL EQUIPMENT MEDICAL SERVICES MEDICAL TECHNOLOGY MEDICAL TREATMENT MEDICARE MOTIVATION NATIONAL HEALTH INSURANCE NUTRITION PATIENTS PHYSICIANS PREMIUMS PRIVATE INSURANCE PROBABILITY PROFESSIONAL ASSOCIATIONS PROGRAMS PROMOTING HEALTH PROVIDER INCENTIVES PUBLIC HEALTH PUBLIC HEALTH CARE PUBLIC SECTOR RATES RISK AVERSION SAVINGS SERVICE DELIVERY SOCIAL INSURANCE SOCIAL SECURITY THAILAND WEIGHT WORKERS The starting point of the debate about the pros and cons of multipayer systems is the suspicion that in many health care systems, consumers do not get sufficient value for money. This contribution argues that one cause may be a non-optimal choice of payment systems. Optimal payment of health care providers importantly depends on the amount of information available to the (prospective) patient. If patients have full information about both the effort exerted and the effectiveness of the service provider, the conventional fee-for-service payment is optimal from their point of view. If patients cannot observe true effort exerted while providers are reasonably homogenous with respect to effectiveness, the optimal payment function consists of a fixed payment and a bonus for especially favorable outcomes in terms of health. If the patient in addition does not know whether a given health care provider effective or ineffective, a special informational rent designed to attract the unrecognized favorable type is appropriate. Now, a government is unlikely to come up with payment systems that closely conform to this conditionality, typically preferring single-payer systems that allow service providers to exercise monopsony power and thus keep health care expenditure low. Multiple-payer systems containing competitive health insurers may have an advantage in designing payment systems in a way that maintains or reinforces provider incentives to do the right thing for their patients, resulting in more value for money. 2013-05-30T18:19:16Z 2013-05-30T18:19:16Z 2004-09 http://documents.worldbank.org/curated/en/2004/09/5643877/multiple-payers-health-care-framework-assessment http://hdl.handle.net/10986/13704 English en_US Health, Nutrition and Population (HNP) discussion paper; CC BY 3.0 IGO http://creativecommons.org/licenses/by/3.0/igo/ World Bank World Bank, Washington, DC Publications & Research :: Working Paper Publications & Research
repository_type	Digital Repository
institution_category	Foreign Institution
institution	Digital Repositories
building	World Bank Open Knowledge Repository
collection	World Bank
language	English en_US
topic	ACCESS TO HEALTH CARE AGED AGENTS AGING BEDS CAPITATION CONSUMERS CREAM SKIMMING DISCRIMINATION HEALTH CARE HEALTH CARE FINANCE HEALTH CARE FINANCING HEALTH CARE PROVIDER HEALTH CARE PROVIDERS HEALTH CARE SECTOR HEALTH CARE SERVICES HEALTH CARE SYSTEMS HEALTH CONDITIONS HEALTH INSURANCE HEALTH INSURERS HEALTH MAINTENANCE ORGANIZATIONS HEALTH OUTCOMES HEALTH RISKS HEALTH SECTOR HEALTH SERVICES HEALTH STATUS HEALTH SYSTEM HEART SURGERY HOSPITAL ADMISSION HOSPITALS HUMAN DEVELOPMENT HUMAN RESOURCES INCOME INTERVENTION LATIN AMERICAN LESSONS LEARNED LOW-INCOME COUNTRIES MANAGED CARE MARGINAL COST MEDICAID MEDICAL ASSOCIATIONS MEDICAL CARE MEDICAL EQUIPMENT MEDICAL SERVICES MEDICAL TECHNOLOGY MEDICAL TREATMENT MEDICARE MOTIVATION NATIONAL HEALTH INSURANCE NUTRITION PATIENTS PHYSICIANS PREMIUMS PRIVATE INSURANCE PROBABILITY PROFESSIONAL ASSOCIATIONS PROGRAMS PROMOTING HEALTH PROVIDER INCENTIVES PUBLIC HEALTH PUBLIC HEALTH CARE PUBLIC SECTOR RATES RISK AVERSION SAVINGS SERVICE DELIVERY SOCIAL INSURANCE SOCIAL SECURITY THAILAND WEIGHT WORKERS
spellingShingle	ACCESS TO HEALTH CARE AGED AGENTS AGING BEDS CAPITATION CONSUMERS CREAM SKIMMING DISCRIMINATION HEALTH CARE HEALTH CARE FINANCE HEALTH CARE FINANCING HEALTH CARE PROVIDER HEALTH CARE PROVIDERS HEALTH CARE SECTOR HEALTH CARE SERVICES HEALTH CARE SYSTEMS HEALTH CONDITIONS HEALTH INSURANCE HEALTH INSURERS HEALTH MAINTENANCE ORGANIZATIONS HEALTH OUTCOMES HEALTH RISKS HEALTH SECTOR HEALTH SERVICES HEALTH STATUS HEALTH SYSTEM HEART SURGERY HOSPITAL ADMISSION HOSPITALS HUMAN DEVELOPMENT HUMAN RESOURCES INCOME INTERVENTION LATIN AMERICAN LESSONS LEARNED LOW-INCOME COUNTRIES MANAGED CARE MARGINAL COST MEDICAID MEDICAL ASSOCIATIONS MEDICAL CARE MEDICAL EQUIPMENT MEDICAL SERVICES MEDICAL TECHNOLOGY MEDICAL TREATMENT MEDICARE MOTIVATION NATIONAL HEALTH INSURANCE NUTRITION PATIENTS PHYSICIANS PREMIUMS PRIVATE INSURANCE PROBABILITY PROFESSIONAL ASSOCIATIONS PROGRAMS PROMOTING HEALTH PROVIDER INCENTIVES PUBLIC HEALTH PUBLIC HEALTH CARE PUBLIC SECTOR RATES RISK AVERSION SAVINGS SERVICE DELIVERY SOCIAL INSURANCE SOCIAL SECURITY THAILAND WEIGHT WORKERS Zweifel, Peter Multiple Payers in Health Care : A Framework for Assessment
relation	Health, Nutrition and Population (HNP) discussion paper;
description	The starting point of the debate about the pros and cons of multipayer systems is the suspicion that in many health care systems, consumers do not get sufficient value for money. This contribution argues that one cause may be a non-optimal choice of payment systems. Optimal payment of health care providers importantly depends on the amount of information available to the (prospective) patient. If patients have full information about both the effort exerted and the effectiveness of the service provider, the conventional fee-for-service payment is optimal from their point of view. If patients cannot observe true effort exerted while providers are reasonably homogenous with respect to effectiveness, the optimal payment function consists of a fixed payment and a bonus for especially favorable outcomes in terms of health. If the patient in addition does not know whether a given health care provider effective or ineffective, a special informational rent designed to attract the unrecognized favorable type is appropriate. Now, a government is unlikely to come up with payment systems that closely conform to this conditionality, typically preferring single-payer systems that allow service providers to exercise monopsony power and thus keep health care expenditure low. Multiple-payer systems containing competitive health insurers may have an advantage in designing payment systems in a way that maintains or reinforces provider incentives to do the right thing for their patients, resulting in more value for money.
format	Publications & Research :: Working Paper
author	Zweifel, Peter
author_facet	Zweifel, Peter
author_sort	Zweifel, Peter
title	Multiple Payers in Health Care : A Framework for Assessment
title_short	Multiple Payers in Health Care : A Framework for Assessment
title_full	Multiple Payers in Health Care : A Framework for Assessment
title_fullStr	Multiple Payers in Health Care : A Framework for Assessment
title_full_unstemmed	Multiple Payers in Health Care : A Framework for Assessment
title_sort	multiple payers in health care : a framework for assessment
publisher	World Bank, Washington, DC
publishDate	2013
url	http://documents.worldbank.org/curated/en/2004/09/5643877/multiple-payers-health-care-framework-assessment http://hdl.handle.net/10986/13704
_version_	1764424201550168064

Multiple Payers in Health Care : A Framework for Assessment

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