Adverse selection, moral hazard, and outlier payment policy

In this article, we analyze the rationale for introducing outlier payments into a prospective payment system for hospitals under adverse selection and moral hazard. The payer has only two instruments: a fixed price for patients whose treatment cost is below a threshold and a cost-sharing rule for outlier patients. We show that a fixed-price policy is optimal when the hospital is sufficiently benevolent. When the hospital is weakly benevolent, a mixed policy solving a trade-off between rent extraction, efficiency, and dumping deterrence must be preferred. We show how the optimal combination of fixed price and partially cost-based payment depends on the degree of benevolence of the hospital, the social cost of public funds, and the distribution of patients severity. [Authors]

Hacia un modelo de análisis de políticas públicas operativ : Un enfoque basado en los actores, sus recursos y las instituciones

Towards an operative analysis of public policies: An approach focused on actors, resources and institutions. This article develops an analytical model which is centred on the individual and collective behaviour of actors involved during different stages of public policy. We postulate that the content and institutional characteristics of public action (dependent variable) are the result of interactions between political-administrative authorities, on the one hand, and, on the other, social groups which cause or suffer the negative effects of a collective problem which public action attempts to resolve (independent variables). The 'game' of the actors depends not only on their particular interests, but also on their resources (money, time, consensus, organization, rights, infrastructure, information, personnel, strength, political support) which they are able to exploit to defend their positions, as well as on the institutional rules which frame these policy games.

Durcissement des lois sociales et santé des migrants forcés: trois ans après (a Loi sur l'asile (LAsi) [Social policy hardening and forced immigrant's health: 3 years after the Asylum Law (LAsi)'s introduction].

In the canton de Vaud, General Practioners (GPs) caring for asylum seekers under the "aide d'urgence" regime can ask for an adaptation of their housing conditions, by filling out a specific form and addressing it to the medical commission responsible for advising the EVAM (the housing institution for asylum seekers) on these issues. The forms addressed to the commission are indicative of a worrisome state of health in this population, especially for mental health. More than 70% report at least one psychiatric diagnosis. Most frequent are anxiety and depressive disorders, as well as many posttraumatic stress disorders, associated with traumatic events both in the country of origin and in Switzerland. Adapting the housing conditions, based on vulnerabilities that the GP has specifically documented, may contribute to improve the health of the most vulnerable asylum seekers.