A Competitive Process for Procuring Health Services: A review of Principles with an Application to Cataract Services

Authors

  • David Dranove Northwestern University's Kellogg
  • Cory Capps Bates White
  • Leemore Dafny Northwestern University's Kellogg

DOI:

https://doi.org/10.11575/sppp.v2i0.42328

Abstract

Government agencies employ a variety of mechanisms for securing goods and services from the private sector. These include posting prices, reimbursing for costs, and soliciting competitive bids.  Procurement of healthcare services offers several unique challenges. The supplier can influence the quantity of services provided. It is often difficult to even specify in advance exactly what services are to be purchased. Lastly, quality is difficult to measure.  Healthcare purchasers have deployed a variety of payment mechanisms to cope with these challenges.  We apply the theory of procurement to the case of cataract surgery. We recommend implementing a system that combines a gatekeeper with competitive bidding among operating physicians who must perform all necessary services, including treatment for complications, within a global fee.  We conclude by discussing the strengths and limitations of this proposal.

References

Besanko, D. et al. 2009. Economics of Strategy. New York: Wiley.

Bhattacharyya, T., et al. 2009. “Measuring the Report Card: The Validity of Pay-for-Performance Metrics in Orthopedic Surgery.” Health Affairs 28 (2): 526-532.

Brook, R., 1991. “Quality of Care: Do We Care?” Annals of Internal Medicine 115 (6): 486-490.

Brook, R., E. McGlynn, and P. Shekelle. 2000. “Defining and Measuring Quality of Care: A Perspective from US Researchers.” International Journal for Quality in Health Care 12 (4): 281-295.

Carter, G., J. Newhouse, and D. Relles. 1990. “How Much Change in the Case Mix Index Is DRG Creep?” Journal of Health Economics 9 (4): 411-428.

Centers for Medicare and Medicaid Services. 2009. “Medicare demonstrations show paying for quality health care pays off.” Press release, August 17, 2009.

Che Y.-K. 1993. “Design Competition through Multidimensional Auctions.” RAND Journal of Economics 24 (4): 668-680.

Cromwell, J., D. Dayhoff, and A. Thumaian. 1997. “Cost Savings and Physician Responses to Global Bundled Payments for Medicare Heart Bypass Surgery.” Health Care Financing Review 19 (1): 41-57.

Dafny, L., 2005. “How Do Hospitals Respond to Price Changes?” American Economic Review 95 (5): 1525-1547.

Dranove, D. 1987. “Rate Setting by Diagnosis Related Groups and Hospital Specialization.” RAND Journal of Economics 18 (3): 417-427.

———. 2001. Economic Evolution of American Health Care. Princeton, NJ: Princeton University Press.

Dusheiko, M., H. Gravelle, R. Jacobs, and P. Smith. 2006. “The Effect of Financial Incentives on Gatekeeping Doctors: Evidence from a Natural Experiment.” Journal of Health Economics 25 (3): 449-478.

Epstein, A. 2007. “Pay for Performance at the Tipping Point.” New England Journal of Medicine 365 (5): 515-517.

Evans, R.G. 1974. “Supplier-Induced Demand: Some Empirical Evidence and Implications.” In The Economics of Health and Medical Care, edited by M. Perlman. London: Macmillan.

Ferrall, C., A.W. Gregory, and W.G. Tholl. 1998. “Endogenous Work Hours and Practice Patterns of Canadian Physicians.” Canadian Journal of Economics 31 (1): 1-27.

Fox, J.R. 1974. Arming America: How the U.S. Buys Weapons. Cambridge, MA: Harvard University Press.

Gaynor, M., and T. Mark. 2002. “Physician Contracting with Health Plans: A Survey of the Literature.” In The Economics of Health Care in Asia-Pacific Countries, edited by Hu Teh-wei and Hsieh Chee-ruey. Cheltenham, UK: Edward Elgar.

Glazier, R.H., J. Klein-Geltink, A. Kopp, and L. Sibley. 2009. “Capitation and Enhanced Fee-forService Models for Primary Care Reform: A Population-based Evaluation.” Canadian Medical Association Journal 180 (11): E72-E81.

Hillman, A., M. Pauly, and J. Kerstein. 1989. “How Do Financial Incentives Affect Physicians’ Clinical Decisions and the Financial Performance of Health Maintenance Organizations?” New England Journal of Medicine 321 (2): 86-92.

Hirao Y. 1993. “Learning and Incentive Problems in Repeated Partnerships.” International Economic Review 34 (1): 101-119.

Hyytinen, A., S. Lundberg, and O. Toivanen. 2007. “Politics and Procurement: Evidence from Cleaning Contracts.” HECER Discussion Paper 196. Helsinki: Helsinki Center of Economic Research.

Institute of Medicine of the National Academies. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: National Academies Press.

ISM (Integrated Service Management). 2002. “Enterprise Supply Management: Delivering Pure Profit.” Palo Alto, CA: Perfect Commerce and Dun & Bradstreet. CD-ROM.

Klein, B., R. Crawford, and A. Alchian. 1978. “Vertical Integration, Appropriable Rents, and the Competitive Contracting Process.” Journal of Law and Economics 21 (2): 297-326.

Laffont, J.J., and J. Tirole. 1988. “The Dynamics of Incentive Contracts.” Econometrica 56 (5): 1153-1175.

———. 1994. A Theory of Incentives in Procurement and Regulation. Cambridge, MA: MIT Press.

Lambert-Mogiliansky, A., and G. Kosenok. 2009. “Fine-Tailored for the Cartel — Favoritism in Procurement.” Review of Industrial Organization 35 (1): 95-121.

Lambert-Mogiliansky, A., and K. Sonin. 2006. “Collusive Market Sharing and Corruption in Procurement.” Journal of Economics & Management Strategy 15 (4): 883-908.

Lindenauer, P., et al. 2007. “Public Reporting and Pay for Performance in Hospital Quality Improvement.” New England Journal of Medicine 356 (5): 486-496.

McGuire, T. 2000. “Physician Agency.” In Handbook of Health Economics, edited by A. Culyer and J. Newhouse. Amsterdam: Elsevier.

Milgrom, P. 1989. “Auctions and Bidding: A Primer.” Journal of Economic Perspectives 3 (3): 3-22.

Milgrom P., and R. Weber. 1982. “A Theory of Auctions and Competitive Bidding.” Econometrica 50 (5): 1089-1122.

Monteverde, K., and D. Teece. 1982. “Supplier Switching Costs and Vertical Integration in the Automobile Industry.” Bell Journal of Economics 13 (1): 206-213.

Mullen, K., R. Frank, and M. Rosenthal. 2009. “Can You Get What You Pay For?” Harvard University. Unpublished manuscript.

Muris, T., D. Scheffman, and P. Spiller. 1992. “Strategy and Transaction Costs: The Organization of Distribution in the Carbonated Soft Drink Industry.” Journal of Economics & Management Strategy 1 (1): 83-128.

Murray, J., S. Greenfield, S. Kaplan, and E. Yano. 1992. “Ambulatory Testing for Capitation and Fee-for-Service Patients in the Same Practice Setting: Relationships to Outcomes.” Medical Care 30 (March): 252-261.

Murray, R. 2009. “Setting Hospital Rates to Control Costs and Boost Quality: The Maryland Experience.” Health Affairs 28 (5): 1395-1405.

Newhouse, J., et al. 1996. Free for All? Cambridge, MA: Harvard University Press.

Pauly, M. 1968. “The Economics of Moral Hazard: Comment.” American Economic Review 58 (3): 531-537.

Premier Inc. 2009. “Model hospital value-based purchasing program continues to improve patient outcomes.” Press release.

Riordan, M., and O. Williamson. 1985. “Asset Specificity and Economic Organization.” International Journal of Industrial Organization 3 (4): 365-378.

Robinson, J., and H. Luft. 1985. “The Impact of Hospital Market Structure on Patient Volume, Average Length of Stay, and the Cost of Care.” Journal of Health Economics 4 (4): 333-356.

Robinson, J., T. Williams, and D. Yanagihara. 2009. “Measurement of and Reward for Efficiency in California’s Pay-For-Performance Program.” Health Affairs 28 (5): 1438-1447.

Rothkopf, M., and R. Harstad. 1994. “Modeling Competitive Bidding: A Critical Essay.” Management Science 40 (3): 364-384.

Shephard, A. 1993. “Contractual Form, Retail Price, and Asset Characteristics in Gasoline Retailing.” RAND Journal of Economics 24 (1): 58-77.

Shleifer, A. 1985. “A Theory of Yardstick Competition.” RAND Journal of Economics 16 (3): 319-327.

Siciliani, L., and J. Hurst. 2004. “Explaining Waiting-Time Variations for Elective Surgeries across OECD Countries.” OECD Economic Studies 38. Paris: Organisation for Economic Co-operation and Development.

Silverman, E., and J. Skinner. 2004. “Medicare Upcoding and Hospital Ownership.” Journal of Health Economics 23 (2): 369-389.

Sorbero, M., et al. 2006. Assessment of Pay-for-Performance Options for Medicare Physician Services: Final Report. Washington, DC: Department of Health and Human Services.

Tirole, J. 1995. The Theory of Industrial Organization. Cambridge, MA: MIT Press.

Wang, R. 1993. “Auctions versus Posted-Price Selling.” American Economic Review 83 (4): 838-851.

White, C. 2008. “Why Did Medicare Spending Growth Slow Down?” Health Affairs 27 (3): 793-802.

Williamson, O. 1971. “Vertical Integration of Production: Market Failure Considerations.” American Economic Review, Papers and Proceedings 61: 112-123.

———. 1976. “Franchise Bidding for Natural Monopolies — in General and with Respect to CATV.” Bell Journal of Economics 7 (1): 73-104.

Young, G., et al. 2007. “Effects of Paying Physicians Based on Their Relative Performance for Quality.” Journal of General Internal Medicine 22 (6): 872-876.

Downloads

Published

2009-12-16

Issue

Section

Research Papers