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Biomedical subjects

William Jack

Publications and source records attributed to William Jack.

4 recordsLinked to original sources
PubMed2006

Optimal risk adjustment with adverse selection and spatial competition.

Paying insurers risk-adjusted prices for covering different individuals can correct selection incentives and induce the market to provide optimal insurance policies. To calculate the optimal risk-adjusted prices we need to know (a) what the optimal policies are; (b) how much they cost; and (c) how competitive the market is. We examine these issues in a model with spatial heterogeneity and adverse selection. Market equilibrium is characterized, and delivery of the socially optimal insurance policies is possible, as long as providers are paid risk-adjusted fees for each individual they serve. When the payment can be made on the basis of an individual's risk, it should be sufficient to cover the expected cost of the socially optimal policy for that person, plus a mark-up. If payments can be made only on the basis of a partially informative signal, the optimal risk-based payments should be adjusted according to a simple linear transformation, identified by Glazer and McGuire [Glazer, J., McGuire, T., 2000. Optimal risk adjustment of health insurance premiums: an application to managed care.

Economic Competition↗
PubMed2005

Purchasing health care services from providers with unknown altruism.

Cost-sharing rules for paying physicians have been advanced as a way of generating incentives for the provision of quality care, while recognizing their potential negative effects on production efficiency. However, the optimal sharing rate typically depends on the degree to which the physician acts in the interest of the patient, what we identify as the physician's altruism. Since the degree of altruism is likely to vary across physicians, and to be private information, the standard rules for setting the cost-sharing rate are unlikely to be optimal. This paper derives conditions for the optimal non-linear cost-sharing mechanism in the presence of asymmetric information about altruism, and shows how it can sometimes be implemented through a menu of linear cost-sharing schemes. The model can be used to rationalize the design of the fund-holder system for general practictioners that operated in the 1990s in the United Kingdom.

Altruism↗
PubMed2003

Contracting for health services: an evaluation of recent reforms in Nicaragua.

Nicaragua has embarked on a reform of the way in which publicly provided medical care is organized and financed. A principal feature of the reforms includes a decentralization of decision-making authority coupled with an increase in local accountability. Local decision-making authority has been increased by allowing managers more freedom to allocate inputs. Accountability has been strengthened by stipulating what is expected of hospitals and health centres in the form of performance agreements, and tying rewards (i.e. bonuses) to the satisfaction of these requirements provides incentives. This paper provides a critical assessment of these reforms, and presents some early evidence of their effects.

Contract Services↗