An Incentive Mechanism for Using Risk Adjuster to Reimburse Health Care Providers

Research output: Working paperDiscussion paper

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An Incentive Mechanism for Using Risk Adjuster to Reimburse Health Care Providers. / Datta, Bipasa.

Department of Economics and Related Studies, University of York, 2009.

Research output: Working paperDiscussion paper

Harvard

Datta, B 2009 'An Incentive Mechanism for Using Risk Adjuster to Reimburse Health Care Providers' Department of Economics and Related Studies, University of York.

APA

Datta, B. (2009). An Incentive Mechanism for Using Risk Adjuster to Reimburse Health Care Providers. Department of Economics and Related Studies, University of York.

Vancouver

Datta B. An Incentive Mechanism for Using Risk Adjuster to Reimburse Health Care Providers. Department of Economics and Related Studies, University of York. 2009.

Author

Datta, Bipasa. / An Incentive Mechanism for Using Risk Adjuster to Reimburse Health Care Providers. Department of Economics and Related Studies, University of York, 2009.

Bibtex - Download

@techreport{d3fd9ca7bff54a78a9c0342940317ed6,
title = "An Incentive Mechanism for Using Risk Adjuster to Reimburse Health Care Providers",
abstract = "Health care providers are almost always universally reimbursed by third party purchasers. As a result, health care purchasers are faced with risk selection challenges. In response, risk adjustment methods are introduced in the reimbursement for services. However, health care providers under this arrangement have incentives to manipulate the risk elements in an attempt to obtain larger payments from the purchasers i.e. the realisation of risk adjuster then becomes sensitive to the providers' upcoding behaviour. Whilst there is usually an outside auditor (e.g from the office of inspector general of the department of health and human services in the United States) who randomly monitors providers' beahviour and imposes penalty in the event that dishonesty is detected, monitoring such behaviour is highly costly. In this paper, we propose a reward scheme to combat such moral hazard problems. We analyse two types of incentive schemes where treatment intensity is contractible in one and not in the other. We show that under both incentive schemes, the honest provider receives the same reward and obtains higher expected utility in comparison to the full information case. Further, with contractible treatment intensity, the contract resembles the full information one.",
author = "Bipasa Datta",
year = "2009",
language = "English",
publisher = "Department of Economics and Related Studies, University of York",
type = "WorkingPaper",
institution = "Department of Economics and Related Studies, University of York",

}

RIS (suitable for import to EndNote) - Download

TY - UNPB

T1 - An Incentive Mechanism for Using Risk Adjuster to Reimburse Health Care Providers

AU - Datta, Bipasa

PY - 2009

Y1 - 2009

N2 - Health care providers are almost always universally reimbursed by third party purchasers. As a result, health care purchasers are faced with risk selection challenges. In response, risk adjustment methods are introduced in the reimbursement for services. However, health care providers under this arrangement have incentives to manipulate the risk elements in an attempt to obtain larger payments from the purchasers i.e. the realisation of risk adjuster then becomes sensitive to the providers' upcoding behaviour. Whilst there is usually an outside auditor (e.g from the office of inspector general of the department of health and human services in the United States) who randomly monitors providers' beahviour and imposes penalty in the event that dishonesty is detected, monitoring such behaviour is highly costly. In this paper, we propose a reward scheme to combat such moral hazard problems. We analyse two types of incentive schemes where treatment intensity is contractible in one and not in the other. We show that under both incentive schemes, the honest provider receives the same reward and obtains higher expected utility in comparison to the full information case. Further, with contractible treatment intensity, the contract resembles the full information one.

AB - Health care providers are almost always universally reimbursed by third party purchasers. As a result, health care purchasers are faced with risk selection challenges. In response, risk adjustment methods are introduced in the reimbursement for services. However, health care providers under this arrangement have incentives to manipulate the risk elements in an attempt to obtain larger payments from the purchasers i.e. the realisation of risk adjuster then becomes sensitive to the providers' upcoding behaviour. Whilst there is usually an outside auditor (e.g from the office of inspector general of the department of health and human services in the United States) who randomly monitors providers' beahviour and imposes penalty in the event that dishonesty is detected, monitoring such behaviour is highly costly. In this paper, we propose a reward scheme to combat such moral hazard problems. We analyse two types of incentive schemes where treatment intensity is contractible in one and not in the other. We show that under both incentive schemes, the honest provider receives the same reward and obtains higher expected utility in comparison to the full information case. Further, with contractible treatment intensity, the contract resembles the full information one.

M3 - Discussion paper

BT - An Incentive Mechanism for Using Risk Adjuster to Reimburse Health Care Providers

PB - Department of Economics and Related Studies, University of York

ER -