Description:
One of the mechanisms that is implemented in the cost containment wave in the health care
sectors in western countries is the definition, by the third-party payer, of a set of preferred
providers. The insured patients have different access rules to such providers when ill. The rules
specify the co-payments and the indemnity the patient obtains if patronizing an out-of-plan care
provider. We propose to study the competitive process among providers in terms of both prices
and qualities. Competition is influenced among other factors by the status of providers as in-plan
or out-of-plan care providers. Also, we face a moral hazard of provider choice related to the
trade-off between freedom to choose and the need to hold down costs.
Our main findings are that we can define a reimbursement scheme when decisions on prices
and qualities are taken simultaneously (that we relate to primary health care sectors) such that
the first-best allocation is achieved. In contrast, some type of regulation is needed to achieve the
optimal solution when decisions are sequential (specialized health care sector). We also derive
some normative conclusions on the way price controls should be implemented in some European
Union Member States.