In many markets, including the new U.S. Exchanges, health insurance plans are paid by risk-adjusted capitation, in some markets combined with reinsurance and other payment mechanisms. This paper proposes three metrics for analyzing the insurer incentives embedded in these complex payment...

This chapter reviews the theory and empirical literature on physician market power, behavior, and motives, referred to collectively as the issue of physician agency. The chapter is organized around an increasingly complex view of the demand conditions facing a physician, beginning with the most...

This paper is concerned with the economics of mental health. We argue that mental health economics is like health economics only more so: uncertainty and variation in treatments are greater; the assumption of patient self-interested behavior is more dubious; response to financial incentives such...

This chapter reviews topics related to the demand for health insurance, including the question of how choice of health insurance should be structured for consumers. After the first section summarizes some of the institutional features of health insurance in high- and middle-income countries, a...

Risk-adjustment systems used to pay health plans in individual health insurance markets have evolved towards better “fit” of payments to plan spending, at the individual and group levels, generally achieved by adding variables used for risk adjustment. Adding variables demands further plan...

This amicus brief was filed in Federal Trade Commission v. Phoebe Putney Health System, Inc., in which the FTC has obtained review of an 11th Circuit decision that insulated a merger of two nonprofit hospitals from antitrust scrutiny. We make two arguments in the amicus brief. First, there is no...

Using insurance claims data from nine large self-insured employers offering 26 alternative health benefit plans, we examine empirically how the composition and utilization for the treatment of depression vary under alternative organizational forms of insurance (indemnity, preferred provider...