The German health care reform of 1997 provides a natural experiment for evaluating the price sensitivity of demand for physicians’ services. As part of the reform, copayments for prescription drugs were increased by up to 200 percent. However, certain groups of people were exempted from the increase, providing a natural control group against which the changed demand for physicians’ services of the treated, those subject to increased co-payments, can be assessed. The differences-in-differences estimates indicate that increased co-payments reduced the number of doctor visits by about 10 percent on average.
This paper analyzes a sequential game where firms decide about outsourcing the production of a non-specific input good to an imperfectly competitive input market. We apply the taxonomy of business strategies introduced by Fudenberg and Tirole (1984) to characterize the different equilibria. We find that outsourcing generally softens competition in the final product market. If firms anticipate the impact of their outsourcing decisions on input prices, there may be equilibria where firms outsource so as to collude or to raise rivals’ costs. We illustrate our analysis using a linear Cournot model.
We analyze the determinants of environmental policy when two firms engage in two types of lobbying against a restriction on allowed pollution: General lobbying increases the total amount of allowed pollution, which is beneficial for both firms. Private lobbying increases the individual pollution standard of the lobbying firm, but has a negative or zero effect on the allowed emissions of the competitor. We determine the lobbying equilibrium and discuss the resulting emission level. In many cases, a higher effectiveness of private lobbying is detrimental for firms and beneficial for environmental quality, as it induces firms to turn towards excessive amounts of relatively unproductive private lobbying.
An important source of conflict surrounding nuclear energy is that with a very small probability, a large-scale nuclear accident may occur. One way to internalize the financial risks associated with such an accident is through mandatory liability insurance. This paper presents estimates of the willingness to pay for increased financial security provided by an extension of coverage, based on the `stated choice' approach. A Swiss citizen with median characteristics may be willing to pay 0.08 cents per kwh to increase coverage beyond the current CHF 0.7 bn. (USD 0.47 bn.). Marginal willingness to pay declines with higher coverage but exceeds marginal cost at least up to a coverage of CHF 4 bn. (USD 2.7 bn.). An extension of nuclear liability insurance coverage therefore may be effciency-enhancing.
We investigate how various institutional settings affect a network provider’s incentives to invest in infrastructure quality. Under reasonable assumptions on demand, investment incentives turn out to be smaller under vertical separation than under vertical integration, though we also provide counter-examples. The introduction of downstream competition for the market can sometimes improve incentives. With suitable non-linear access prices investment incentives under separation become identical to those under integration.
This study applies conjoint analysis (CA) to estimate the marginal willingness-to-pay (MWTP) of elderly individuals for a reduction of the risk of fracture of the femur. The good in question are hypothetical hip protectors which lower the risk of a fracture by different amounts. Other attributes are ease of handling, wearing comfort, and out-of-pocket cost. Thus, the novelty of the present work lies in its letting risk reduction be traded off against several attributes. In 500 face-to-face interviews, pensioners stated whether or not they would buy the product. Results suggest that MWTP for wearing comfort exceeds that for risk reduction. Indeed, willingness to pay for the product as a whole is negative, indicating that it should not be included as a mandatory benefit in health insurance.
This contribution purports to come up with reform proposals that promise to improve the benefit-cost ratio in health from the point of view of taxpayers and (potential) patients. It starts by noting that a high and increasing share of health care expenditure in the GDP does not per se indicate a need for reform. Rather, the guiding idea is that decisions in the health care sector should be tied more closely to the preferences of consumers, who must obtain more ways to express their willingness-to-pay. The 10 proposals are directed to health insurers, physicians and medical associations, hospital management, and policy makers proper. Moreover, initial steps for implementing them are sketched, such as abolishing the division of lines in the regulation of (private) insurance, freeing health insurers from any-willing-provider clauses, refraining from imposing uniform nationwide fee schedules, and directly subsidizing poor consumers for buying health insurance rather than institutions such as hospitals and homes for long-term care.
We analyse post-war Dutch migration to New Zealand. We document that history, reflect on analytical and econometric modelling and then combine a sample of Dutch migrants in New Zealand with a representative sample of Dutch in The Netherlands to estimate wage equations and the determinants of the migration decision. We use the results for ex post evaluation of the migration decision.
Health policy makers know that their decisions affect the chances of well-being and survival of individuals and that they implicitly are valuing human lives. Evidence with regard to willingness-to-pay (WTP) informs about the value individuals themselves put on these chances; it thus holds the promise of contributing to consistent decisions that lead to an improved benefit-cost ratio of health services for (potential) patients. However, such improvement is more likely if information about WTP is used by competing health insurers rather than the government.
The efficiency of hospitals is of interest to health insurers, government authorities and hospital management itself. However, econometric methods for determining (in)efficiency have severe drawbacks since hospitals are multiproduct firms and because the duality between production and cost functions cannot be assumed. In this work, non-parametric, deterministic data envelopment analysis (DEA) is used to measure the relative inefficiency of 89 Swiss hospitals covering the years 1993-1996 (310 observations). Special attention is given to the role of patient days in the production of health. The findings depend on whether patient days are viewed as an input of patient time or as an output, as in previous studies. While the probability of a unit being inefficient cannot be explained using the available data, the degree of overall inefficiency is shown to significantly depend on the financial incentives faced by management, in particular due to subsidization. Private hospitals do not seem to be less inefficient than public ones; however, this may be caused by their 'overusing' inputs that in fact are valued as amenities by patients. This consideration points to an important limitation in applying the purely quantitative criteria of DEA to hospitals.
