Marie Allard

Treatment and referral decisions under different physician payment mechanisms

This paper analyzes and compares the incentive properties of some common payment mechanisms for GPs, namely fee for service (FFS), capitation and fundholding. It focuses on gatekeeping GPs and it specifically recognizes GPs heterogeneity in both ability and altruism. It also allows inappropriate care by GPs to lead to more serious illnesses. The results are as follows. Capitation is the payment mechanism that induces the most referrals to expensive specialty care. Fundholding may induce almost as much referrals as capitation when the expected costs of GPs care are high relative to those of specialty care. Although driven by financial incentives of different nature, the strategic behaviors associated with fundholding and FFS are very much alike. Finally, whether a regulator should use one or another payment mechanism for GPs will depend on (i) his priorities (either cost-containment or quality enhancement) which, in turn, depend on the expected cost difference between GPs care and specialty care, and (ii) the distribution of profiles (diagnostic ability and altruism levels) among GPs.

Payment mechanism and GP self-selection: capitation versus fee for service.

This paper analyzes the consequences of allowing gatekeeping general practitioners (GPs) to select their payment mechanism. We model GPs’ behavior under the most common payment schemes (capitation and fee for service) and when GPs can select one among them. Our analysis considers GP heterogeneity in terms of both ability and concern for their patients’ health. We show that when the costs of wasteful referrals to costly specialized care are relatively high, fee for service payments are optimal to maximize the expected patients’ health net of treatment costs. Conversely, when the losses associated with failed referrals of severely ill patients are relatively high, we show that either GPs’ self-selection of a payment form or capitation is optimal. Last, we extend our analysis to endogenous effort and to competition among GPs. In both cases, we show that self-selection is never optimal.

Temporary pareto optimum theory

Abstract The purpose of this paper is to introduce bounded rationality in the framework of Pareto optimality. This is done by altering the usual definition of the attainable set to take account of the fact that agents are represented by expectation functions induced by their learning processes. Two polar cases are examined. First, we show that a temporary Pareto optimum is a temporary competitive equilibrium when expectations are strongly Roy-consistent. Second, in the general case of weak Roy-consistency, the temporary version of the second welfare theorem cannot always be true; moreover, the characterizations of a temporary Pareto optimum bear some resemblance to those of optimal taxation in an atemporal second best framework.

Aversions to Impatience, Uncertainty and Illiquidity

Edmond Malinvaud has not only fixed the French terminology in Econometrics, Microeconomics, but he has also derived scientific results of prime interest concerning the intertemporal equilibrium or the synthesis between the Walrasian microeconomics and the Keynesian macroeconomics. Malinvaud has also opened new research directions, which are often less known. One of these directions is developed in this paper. Due to their underlying assumptions, the standard concepts of risk aversion and impatience are generally defined separately and represented by scalar measures. This implies many shortcomings, for instance, the risk aversion remain unchanged, whatever type of risk is considered. This paper provides a more complete analysis of aversions, which clearly emphasizes their multidimensionality and the necessity for the measures of risk aversion and impatience aversion to be defined jointly.