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Optimal payment schemes for physicians

机译：医师的最佳付款方案

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Increasingly, physicians' payment schemes are being reformed to enhance performance and to ensure an optimal allocation of scarce medical resources. The empirical evidence points towards the use of mixed payment schemes that appear better at achieving efficiency than either lump sum payments (such as capitation) or piece rates (fee for service). Yet, this alleged superiority remains to be established from a theoretical standpoint. The Principal-Agent model developed in this paper offers a contribution in this line, with a primary care physician as agent and a public regulator as principal. Alternative specifications of the principals objective function are considered in the model (efficiency versus fairness). Uncertainty is introduced by two random variables that represent the probability for an individual of being ill and his productivity parameter which determines the amount of resources (the physician's effort in particular) necessary to restore health. The relationship is characterised by information asymmetry since the physician is assumed to observe both variables after the contract has been signed, but before choosing his effort level. Both selection and moral hazard issues are addressed in the model and the results show that, under GP risk neutrality, mixed payment schemes fully correct for both types of information asymmetry.
机译：越来越多地对医生的付款方案进行改革，以提高绩效并确保稀缺医疗资源的最佳分配。经验证据表明，使用混合付款方案比一次性付款（例如人头费）或计件工资（服务费）更能提高效率。然而，从理论的角度来看，这种所谓的优势仍有待确立。本文开发的委托人-代理模型在这一方面做出了贡献，主要护理医师为代理人，公共监管者为委托人。在模型中考虑了主要目标函数的替代规范（效率与公平性）。不确定性是由两个随机变量引入的，这两个变量代表一个人生病的可能性，而生产率参数决定了恢复健康所必需的资源量（尤其是医生的努力）。这种关系的特征是信息不对称，因为假定医师在合同签订后但在选择其努力水平之前会观察两个变量。该模型同时解决了选择问题和道德风险问题，结果表明，在GP风险中性的情况下，混合支付方案可以完全纠正两种类型的信息不对称。

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