scholarly journals Performance Pay in Insurance Markets: Evidence from Medicare

2021 ◽  
pp. 1-45
Author(s):  
Michele Fioretti ◽  
Hongming Wang

Abstract Public procurement bodies increasingly resort to pay-for-performance contracts to promote efficient spending. We show that firm responses to pay-for-performance can widen the inequality in accessing social services. Focusing on the quality bonus payment initiative in Medicare Advantage, we find that higher quality-rated insurers responded to bonus payments by selecting healthier enrollees with premium differences across counties. Selection is profitable because the quality rating fails to adjust for differences in enrollee health. Selection inflated the bonus payments and shifted the supply of highrated insurance to the healthiest counties, reducing access to lower-priced, higher-rated insurance in the riskiest counties.

2021 ◽  
Vol 66 ◽  
pp. 113-117
Author(s):  
M.O. Buk

This article is dedicated to the analysis of the essential hallmarks of social services procurement. The attention is focused on the absence of the unity of the scientists’ thoughts as for the definition of the term “social procurement”. It has been determined that in the foreign scientific literature the scientists to denote the term “social procurement” use the notions “social contracting”, “social order” and “social commissioning”, and they use these notions with slightly different meanings. Therefore, the notion “social procurement” is defined as: 1) activity of a country; 2) form of the state support; 3) complex of measures; 4) legal mechanism. The article has grounded the expediency of the definition of social procurement in the legal relations of social care as a special legal way to influence the behavior of the parties of the social care legal relations. The publication advocates the idea that social procurement is one of the conditions for the rise of the state and private sectors partnership. The state-private partnership in the legal relations regarding the provision of social services is proposed to be defined as cooperation between Ukraine, AR of Crimea, territorial communities represented by the competent state bodies, self-government bodies (authorized bodies in the sphere of social services provision) and legal entities, but for the state and municipal enterprises and establishments, and organizations (providers of social services) regarding the provision of social services, which is carried out on the basis of an agreement and under the procedure set by the Law of Ukraine “On Social Services” and other legal acts that regulate the social care legal relations. The article substantiates the thesis that the subject of the social procurement is social services and resolution of social issues of the state/regional/local levels in the aspect of the satisfaction of the needs of people/families for social services (state/regional/local programs of social services). It has been determined that the main forms of realization of the social procurement in the social care legal relations are public procurements of social services and financing of the state/regional/local programs of social services. The public procurement of social services is carried out under the procedure set by the Law of Ukraine “On  Public Procurement” taking into account the special features determined by the Law of Ukraine “On Social Services”. The social procurement in the form of financing of the state/regional/local programs of social services is decided upon the results of the tender announced by a client according to the plan for realization of the corresponding target program.


Author(s):  
Amitabh Chandra ◽  
Craig Garthwaite

In this article, we develop an economic framework for Medicare reform that highlights trade-offs that reform proposals should grapple with, but often ignore. Central to our argument is a tension in administratively set prices, which may improve short-term efficiency but do so at the expense of dynamic efficiency (slowing innovations in new treatments). The smaller the Medicare program is relative to the commercial market, the less important this is; but in a world where there are no market prices or the private sector is very small, the task of setting prices that are dynamically correct becomes more complex. Reforming Medicare should focus on greater incentives to increase competition between Medicare Advantage plans, which necessitates a role for government in ensuring competition; premium support; less use of regulated prices; and less appetite for countless “pay for performance” schemes. We apply this framework to evaluate Medicare for All proposals.


Author(s):  
James C. Robinson ◽  
Stephen M. Shortell ◽  
Diane R. Rittenhouse ◽  
Sara Fernandes-Taylor ◽  
Robin R. Gillies ◽  
...  

This paper measures the extent to which medical groups experience external pay-for-performance incentives based on quality and patient satisfaction and the extent to which these groups pay their primary care and specialist physicians using similar criteria. Over half (52%) of large medical groups received bonus payments from health insurance plans in the period 2006–2007 based on measures of quality and patient satisfaction. Medical groups facing external pay-for-performance incentives are more likely to pay their primary care physicians (odds ratio [OR] 4.5; p<.001) and specialists (OR 2.5; p=.07) based on quality and satisfaction. Groups facing capitation payment incentives to control costs are more likely to pay member physicians on salary and less likely to pay based on productivity (p<.001 for primary care; p<.05 for specialists) than groups paid by insurers on a fee-for-service basis.


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