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Essays on information, competition and quality in health care provider markets.

机译:关于医疗保健提供者市场中的信息,竞争和质量的论文。

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摘要

This dissertation explores the impact of information and competition on the market for cardiac bypass graft (CABG) surgery in Pennsylvania.;In the first chapter, I consider the welfare economics of firm entry when input supply is not perfectly elastic. I assess these predictions empirically by examining the impact of the 1996 repeal of certificate-of-need (CON) legislation in Pennsylvania. Increased entry led to a redistribution of surgeries from lower- to higher-quality surgeons. The value of the improved outcomes due to this redistribution was roughly equal to the additional fixed costs incurred by new entrants.;In the second chapter, I consider the impact of quality "report cards" when performance data alters both surgeons' pecuniary incentives (i.e. extrinsic motivation) and incentives unrelated to profit (i.e. intrinsic motivation). Extrinsic incentives due to quality reporting led to a .09 percentage point (three percent) decline in mortality. Consistent with a mixed model of objectives, information on performance that was new to surgeons and unrelated to patient demand led to an intrinsic response three times as large as surgeon response to profit incentives.;The third chapter explores the relative roles of privately and publicly provided information in consumer choice of surgeons. I find that market based mechanisms explain about half of the response to quality prior to the release of report cards.
机译:本文探讨了信息和竞争对宾夕法尼亚州心脏搭桥术(CABG)手术市场的影响。在第一章中,我考虑了当输入供给不是完全弹性时企业进入的福利经济学。我通过检查1996年废除宾夕法尼亚州的需要证明(CON)法规的影响,通过经验评估了这些预测。进入的增加导致外科手术从低质量的外科医生到高质量的外科医生的重新分配。由于这种重新分配而产生的改善结果的价值大致等于新进入者产生的额外固定成本。;在第二章中,我考虑了当绩效数据改变两位外科医生的金钱激励时,质量“报告卡”的影响(即外在动机)和与利润无关的动机(即内在动机)。由于质量报告而产生的外部激励导致死亡率下降了0.09个百分点(百分之三)。与目标的混合模型相一致,对于外科医生来说是新的且与患者需求无关的性能信息导致其内在反应是外科医生对利润激励的反应的三倍。;第三章探讨了私人和公开提供的相对作用消费者选择外科医生方面的信息。我发现,基于市场的机制可以解释报告卡发布之前对质量的一半响应。

著录项

  • 作者

    Kolstad, Jonathan Thompson.;

  • 作者单位

    Harvard University.;

  • 授予单位 Harvard University.;
  • 学科 Economics General.;Health Sciences Health Care Management.
  • 学位 Ph.D.
  • 年度 2009
  • 页码 117 p.
  • 总页数 117
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 经济学 ; 预防医学、卫生学 ;
  • 关键词

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