IDEAS home Printed from https://ideas.repec.org/a/aea/aecrev/v113y2023i6p1530-71.html
   My bibliography  Save this article

Optimal Contracting with Altruistic Agents: Medicare Payments for Dialysis Drugs

Author

Listed:
  • Martin Gaynor
  • Nirav Mehta
  • Seth Richards-Shubik

Abstract

We study health-care provider agency and optimal payments, considering an expensive medication for dialysis patients. Using Medicare claims data we estimate a structural model of treatment decisions, in which providers differ in their altruism and marginal costs, and this heterogeneity is unobservable to the government. In a novel application of nonlinear pricing methods, we empirically characterize the optimal contracts in this environment. The optimal contracts eliminate medically excessive dosages and reduce expenditures, resulting in approximately $300 million in annual gains from better contracting. This approach could be applied to a broad class of problems in healthcare payment policy.

Suggested Citation

  • Martin Gaynor & Nirav Mehta & Seth Richards-Shubik, 2023. "Optimal Contracting with Altruistic Agents: Medicare Payments for Dialysis Drugs," American Economic Review, American Economic Association, vol. 113(6), pages 1530-1571, June.
    • Handle: RePEc:aea:aecrev:v:113:y:2023:i:6:p:1530-71
    DOI: 10.1257/aer.20210208
    as

    Download full text from publisher

    File URL: https://www.aeaweb.org/doi/10.1257/aer.20210208
    Download Restriction: no
    File URL: https://www.aeaweb.org/doi/10.1257/aer.20210208.appx
    Download Restriction: no
    File URL: https://www.aeaweb.org/doi/10.1257/aer.20210208.ds
    Download Restriction: Access to full text is restricted to AEA members and institutional subscribers.
    File URL: https://libkey.io/10.1257/aer.20210208?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Joseph E. Aldy & W. Kip Viscusi, 2008. "Adjusting the Value of a Statistical Life for Age and Cohort Effects," The Review of Economics and Statistics, MIT Press, vol. 90(3), pages 573-581, August.
    2. Train,Kenneth E., 2009. "Discrete Choice Methods with Simulation," Cambridge Books, Cambridge University Press, number 9780521766555, November.
    3. Xavier Vives, 2001. "Oligopoly Pricing: Old Ideas and New Tools," MIT Press Books, The MIT Press, edition 1, volume 1, number 026272040x, December.
    4. Varadhan, Ravi & Gilbert, Paul, 2009. "BB: An R Package for Solving a Large System of Nonlinear Equations and for Optimizing a High-Dimensional Nonlinear Objective Function," Journal of Statistical Software, Foundation for Open Access Statistics, vol. 32(i04).
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Martin Gaynor & Nirav Mehta & Seth Richards-Shubik, 2020. "Optimal Contracting with Altruistic Agents: A Structural Model of Medicare Payments for Dialysis Drugs," NBER Working Papers 27172, National Bureau of Economic Research, Inc.
    2. Lapo Filistrucchi & Tobias J. Klein, 2013. "Price Competition in Two-Sided Markets with Heterogeneous Consumers and Network Effects," Working Papers 13-20, NET Institute.
    3. Hammitt, James K. & Herrera-Araujo, Daniel, 2018. "Peeling back the onion: Using latent class analysis to uncover heterogeneous responses to stated preference surveys," Journal of Environmental Economics and Management, Elsevier, vol. 87(C), pages 165-189.
    4. Cem Tekeşin & Shihomi Ara, 2014. "Measuring the Value of Mortality Risk Reductions in Turkey," IJERPH, MDPI, vol. 11(7), pages 1-33, July.
    5. Barrientos, Manuel & Lavin, Felipe Vasquez & Ponce Oliva, Roberto D., 2020. "Assessing the Incorporation of Latent Variables in the Estimation of the Value of a Statistical Life," EfD Discussion Paper 20-22, Environment for Development, University of Gothenburg.
    6. Martin Gaynor & Nirav Mehta & Seth Richards-Shubik, 2020. "Optimal Contracting with Altruistic Agents," University of Western Ontario, Centre for Human Capital and Productivity (CHCP) Working Papers 20203, University of Western Ontario, Centre for Human Capital and Productivity (CHCP).
    7. Hai Jiang & Rui Chen & He Sun, 2017. "Multiproduct price optimization under the multilevel nested logit model," Annals of Operations Research, Springer, vol. 254(1), pages 131-164, July.
    8. Zhifeng Gao & Ted C. Schroeder, 2009. "Consumer responses to new food quality information: are some consumers more sensitive than others?," Agricultural Economics, International Association of Agricultural Economists, vol. 40(3), pages 339-346, May.
    9. Cheng, Leilei & Yin, Changbin & Chien, Hsiaoping, 2015. "Demand for milk quantity and safety in urban China: evidence from Beijing and Harbin," Australian Journal of Agricultural and Resource Economics, Australian Agricultural and Resource Economics Society, vol. 59(2), April.
    10. Wen, Chieh-Hua & Huang, Chia-Jung & Fu, Chiang, 2020. "Incorporating continuous representation of preferences for flight departure times into stated itinerary choice modeling," Transport Policy, Elsevier, vol. 98(C), pages 10-20.
    11. Rodney Beard, 2015. "N-Firm Oligopoly With General Iso-Elastic Demand," Bulletin of Economic Research, Wiley Blackwell, vol. 67(4), pages 336-345, October.
    12. Johannes Buggle & Thierry Mayer & Seyhun Orcan Sakalli & Mathias Thoenig, 2023. "The Refugee’s Dilemma: Evidence from Jewish Migration out of Nazi Germany," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 138(2), pages 1273-1345.
    13. Ciwei Dong & Liu Yang & Chi To Ng, 2020. "Quantity Leadership for a Dual-Channel Supply Chain with Retail Service," Asia-Pacific Journal of Operational Research (APJOR), World Scientific Publishing Co. Pte. Ltd., vol. 37(02), pages 1-32, March.
    14. Kaplow, Louis & Shapiro, Carl, 2007. "Antitrust," Handbook of Law and Economics, in: A. Mitchell Polinsky & Steven Shavell (ed.), Handbook of Law and Economics, edition 1, volume 2, chapter 15, pages 1073-1225, Elsevier.
    15. Christelis, Dimitris & Dobrescu, Loretti I. & Motta, Alberto, 2020. "Early life conditions and financial risk-taking in older age," The Journal of the Economics of Ageing, Elsevier, vol. 17(C).
    16. Ortega, David L. & Wang, H. Holly & Wu, Laping & Hong, Soo Jeong, 2015. "Retail channel and consumer demand for food quality in China," China Economic Review, Elsevier, vol. 36(C), pages 359-366.
    17. Tina Birgitte Hansen & Jes Sanddal Lindholt & Axel Diederichsen & Rikke Søgaard, 2019. "Do Non-participants at Screening have a Different Threshold for an Acceptable Benefit–Harm Ratio than Participants? Results of a Discrete Choice Experiment," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 12(5), pages 491-501, October.
    18. Doyle, Orla & Fidrmuc, Jan, 2006. "Who favors enlargement?: Determinants of support for EU membership in the candidate countries' referenda," European Journal of Political Economy, Elsevier, vol. 22(2), pages 520-543, June.
    19. McCarthy, Ian M., 2016. "Advertising intensity and welfare in an equilibrium search model," Economics Letters, Elsevier, vol. 141(C), pages 20-26.
    20. Tovar, Jorge, 2012. "Consumers’ Welfare and Trade Liberalization: Evidence from the Car Industry in Colombia," World Development, Elsevier, vol. 40(4), pages 808-820.

    More about this item

    JEL classification:

    • D64 - Microeconomics - - Welfare Economics - - - Altruism; Philanthropy; Intergenerational Transfers
    • D86 - Microeconomics - - Information, Knowledge, and Uncertainty - - - Economics of Contract Law
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • J33 - Labor and Demographic Economics - - Wages, Compensation, and Labor Costs - - - Compensation Packages; Payment Methods
    • L21 - Industrial Organization - - Firm Objectives, Organization, and Behavior - - - Business Objectives of the Firm

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:aea:aecrev:v:113:y:2023:i:6:p:1530-71. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Michael P. Albert (email available below). General contact details of provider: https://edirc.repec.org/data/aeaaaea.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.