Doctors´ remuneration schemes and hospital competition in two-sided markets with common network externalities

This paper uses a two-sided market model of hospital competition to study the implications of di§erent remunerations schemes on the physiciansí side. The two-sided market approach is characterized by the concept of common network externality (CNE) introduced by Bardey et al. (2010). This type of externality occurs when occurs when both sides value, possibly with di§erent intensities, the same network externality. We explicitly introduce e§ort exerted by doctors. By increasing the number of medical acts (which involves a costly e§ort) the doctor can increase the quality of service o§ered to patients (over and above the level implied by the CNE). We Örst consider pure salary, capitation or fee-for-service schemes. Then, we study schemes that mix fee-for-service with either salary or capitation payments. We show that salary schemes (either pure or in combination with fee-for-service) are more patient friendly than (pure or mixed) capitations schemes. This comparison is exactly reversed on the providersíside. Quite surprisingly, patients always loose when a fee-for-service scheme is introduced (pure of mixed). This is true even though the fee-for-service is the only way to induce the providers to exert e§ort and it holds whatever the patientsívaluation of this e§ort. In other words, the increase in quality brought about by the fee-for-service is more than compensated by the increase in fees faced by patients.

Ciclos económicos, capital bancario y nuevas opciones de política económica

El objetivo de este trabajo es utilizar algunos hechos estilizados de la "Gran recesión", específicamente la drástica caída en el nivel de capitalización bancario, para analizar la relación entre los ciclos financieros y los ciclos reales, así como la efectividad de la política monetaria no convencional y las políticas macroprudenciales. Para esto, en el primer capítulo se desarrolla una microfundamentación de la banca a partir de un modelo de Costly State Verification, que es incluido posteriomente en distintas especificaciones de modelos DSGE. Los resultados muestran que: (i) los ciclos financieros y los ciclos económicos pueden relacionarse a partir del deterioro del capital bancario; (ii) Las políticas macroprudenciales y no convencionales son efectivas para moderar los ciclos económicos, pero son costosas en términos de recursos e inflación.