Should we be afraid of managed care?: a theoretical assessment

Managed caIe capitation contracts provide monetary incentives for doctoIs to save medical costs while standard health insurance contracts do noto The papeI proposes an alternative model for insurance markets which is used to analyze managed caIe contracts. In our model, households would like to buy insurance for the possible need of a service. The distinctive aspect of our model is that providers of service have privileged information on the most appropriate procedure to be followed. In the managed care application of the model, doctors are the providers of the service and through a diagnosis have better information of the patient's health condition. Equilibrium in our model is always constrained eflicient. A partial capitation contract arises when both the cost and net benefits of treatment are high enough. We show that a capitation contract provides incentives for doctors: i) to care about the likelihood households will obtain the good state of nature (altruistic behamor); and ii) to save medical costs (managed care behamor). Doctors, in this case, choose less medically eflicient treatments as they would choose under a standard health insurance contract. Besides this, household' welfare is increased in comparison to the standard contract. This increased welfare translates into a revealed preference for the capitation contract.

On the cost of sympathy : a alternative model of insurance markets

The paper provides an alternative model for insurance market with three types of agents: households, providers of a service and insurance companies. Households have uncertainty about future leveIs of income. Providers, if hired by a household, perform a diagnoses and privately learn a signal. For each signal there is a procedure that maximizes the likelihood of the household obtaining the good state of nature. The paper assumes that providers care about their income and also about the likelihood households will obtain the good state of nature (sympathy assumption). This assumption is satisfied if, for example, they care about their reputation or if there are possible litigation costs in case they do not use the appropriate procedure. Finally, insurance companies offer contracts to both providers and households. The paper provides sufficient conditions for the existence of equilibrium and shows that the sympathy assumption 1eads to a 10ss of welfare for the households due to the need to incentive providers to choose the least expensive treatment.