Mitigating Risk Selection in Healthcare Entitlement Programs: A Beneficiary-Level Competitive Bidding Approach

Many developed countries rely, to varying degrees, on competition among private health plans to obtain affordable and high-quality health insurance for their residents. Incorporating beneficiary-level competitive bidding into these healthcare systems can better align the incentives of these health plans, increase their willingness to enroll, and serve the sickest and most vulnerable patients while keeping costs manageable. We identify two digitally enabled program designs that allow private insurance plans to competitively bid to enroll individual beneficiaries. Compared with those used in existing entitlement programs, these designs always make a larger share of the beneficiary population profitable to enroll, thereby increasing willingness of the plans to enroll the most costly beneficiaries and improving access to care. On simulating the conditions of existing real-word healthcare entitlement programs, we found that these new designs actually tend to lower the tax burden in up to 83% of simulations. The research findings suggest that these new designs hold great promise in achieving the dual aim of improved access and lower costs. We believe that findings from this research can guide policymakers implement policies that will enroll more beneficiaries and cost the taxpayers less.

IT Procurement Case Study of the Japanese Government within the Institutional Theory Context

Japanese government has sought to create and implement an IT procurement system that fosters competitive bidding. This study examines 31 IT procurement case studies surrounding the 2016 launch of Japan’s social security and tax number system with which the author was directly involved. It identifies a disjunction between IT procurement as a legal and a social system, wherein the government and vendors acknowledge that some vendors will inevitably be awarded contracts. The Japanese government should thus reconsider its IT procurement system and abandon competitiveness as a goal.

A competitive bidding decision-making model considering correlation

A competitive bidding decision-making model considering correlation

A competitive bidding decision-making model considering correlation

A competitive bidding decision-making model considering correlation

Choice, quality and patients’ experience: evidence from a Finnish physiotherapy service

We study the relationship between patient choices and provider quality in a rehabilitation service for disabled patients who receive the service frequently but do not have access to quality information. Previous research has found a positive relationship between patient choices and provider quality in health services that patients typically do not have previous experience or use frequently. We contribute by examining choices of new patients and experienced patients who were either forced to switch or actively switched their provider. In the analysis, we combine register data on patients’ choices and switches with provider quality data from a competitive bidding, and estimate conditional logit choice models. The results show that all patients prefer high-quality providers within short distances. We find that the willingness to travel for quality is highest among new patients and active switchers. These results suggest that new patients and active switchers compare different alternatives more thoroughly, whereas forced switchers choose their new provider in limited time leading into poorer choices.