Quality and valuation problems in healthcare.

摘要

This dissertation is composed of three different research problems that persist in healthcare management today. Chapter 1 addresses an industry level concern and concentrates on the quality implications of diverse managed care structures. We compare the economic incentives of health plans that participate in exclusive dealing with those that offer choice and evaluate the divergence of competitive offerings from social efficiency. We analyze provider and managed care behavior in homogenous and heterogeneous markets and characterize conditions in which opposing incentives of heterogeneous plans help deliver an actuarially fair offering to consumers that might even eliminate the need for managed care regulation.; Chapter 2 focuses on capital investment problems in healthcare and specifically takes on the financial valuation of information technology projects. We criticize the highly stylized examples in real-options literature that are not applicable to small to medium-scale operations and argue that most real-life projects, especially in healthcare, are "exotic" options with irregular dividends that require individual customization of decision models. Using data from actual case studies, we create a prospective value template for a generic PACS implementation based on risk-adjustment and modeling developments that surfaced with real-options analyses. Under capitation and fee-for-service reimbursement, financial implications and response to operational flexibility change beyond what intuition suggests. Our examples underline that generalized biases toward reimbursement methods have to be replaced with individually-tailored numerical analyses. Moreover, we evaluate the option to switch reimbursement contracts and find that it is strikingly more valuable than any operating flexibility. We, therefore, suggest that interim autonomy over payer contracts during technology investments might prove to be a crucial policy tool that fosters effective change in healthcare.; Chapter 3 explores the rationale for publishing quality report cards. We derive an economic expression for the welfare value to be generated by public reporting of information and present an application on NYS Cardiac Surgery Reports. Likewise, we investigate the consequences of inaccurate reporting and analyze the extent of welfare loss. Our key conclusions underscore the fact that erroneous reporting might be more detrimental to all players than the absence of information.