中文摘要
我们以一种用于透析患者的昂贵药物为对象，研究医疗服务提供者的代理问题与最优支付。我们利用医疗保险理赔数据估计治疗决策的结构模型，其中，医疗服务提供者在利他程度和边际成本方面存在差异，而政府无法观察到这种异质性。通过创新性地应用非线性定价方法，我们对这一环境下的最优契约进行了实证刻画。最优契约消除了医学上过量的用药剂量并减少了支出，改进契约由此带来的年度收益约为3亿美元。这一方法可应用于医疗支付政策中的一大类问题。(JEL D64, D86, H51, I11, I13, J33, L21)
Abstract
We study health-care provider agency and optimal payments, considering an expensive medication for dialysis patients. Using Medicare claims data we estimate a structural model of treatment decisions, in which providers differ in their altruism and marginal costs, and this heterogeneity is unobservable to the government. In a novel application of nonlinear pricing methods, we empirically characterize the optimal contracts in this environment. The optimal contracts eliminate medically excessive dosages and reduce expenditures, resulting in approximately $300 million in annual gains from better contracting. This approach could be applied to a broad class of problems in health-care payment policy. (JEL D64, D86, H51, I11, I13, J33, L21)