Literature DB >> 31450142

Health provider networks with private contracts: Is there under-treatment in narrow networks?

Jan Boone1.   

Abstract

Contracts between health insurers and providers are private. By modelling this explicitly, we find the following. Insurers with bigger provider networks, pay providers higher fee-for-service rates. This makes it more likely that a patient is treated and hence health care costs and utilization increase with provider network size. Although providers are homogeneous, the welfare maximizing provider network can consist of two or more providers. Provider profits are positive whereas they would be zero with public contracts. Increasing transparency of provider prices increases welfare only if consumers can "mentally process" the prices of all treatments involved in an insurance contract. If not, it tends to reduce welfare.
Copyright © 2019 The Author. Published by Elsevier B.V. All rights reserved.

Entities:  

Keywords:  Any Willing Provider laws; Capitation; Fee-for-service; Price transparency; Private contracts; Two-part tariffs

Year:  2019        PMID: 31450142     DOI: 10.1016/j.jhealeco.2019.102222

Source DB:  PubMed          Journal:  J Health Econ        ISSN: 0167-6296            Impact factor:   3.883


  1 in total

1.  The Hidden Cost of the Opioid Epidemic in the United States: Drug Screening in Insurance Claims.

Authors:  Jeremy J Day-Storms; Erin M Kren; Jason Bush; Tatiana Souslova; William Kerr; Geoffrey S Baird
Journal:  Ther Drug Monit       Date:  2021-02-01       Impact factor: 3.118

  1 in total

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