Journal of Economics and Management Strategy, Feb 12, 2021
We investigate the e¤ect of competition in the nursing homes sector with a two-sided market appro... more We investigate the e¤ect of competition in the nursing homes sector with a two-sided market approach. More precisely, we investigate the distributional implications across the three key actors involved (residents, nurses and nursing homes) that arise from the twosidedness of the market. Within a Hotelling set up, nursing homes compete for residents and for nurses, who provide quality to residents, by setting residents price and nurses wage. Nurses are assumed altruistic and therefore motivated to provide quality. The market is twosided because: i) a higher number of residents a¤ects nurses workload, which a¤ects their willingness to provide labour supply; and ii) a higher number of nurses a¤ects residents' quality through a better matching process and by relaxing nurses time constraints. Our key …ndings are that i) the two-sidedness of the market leads to higher wages for nurses, which makes the nurses better o¤; ii) this is then passed to residents in the form of higher prices, which makes residents worse o¤; iii) nursing homes pro…ts are instead una¤ected. In contrast, when nurses wages are regulated, the two-sidedness of the market implies a transfer between residents and nursing homes. When residents price are regulated, it implies a transfer between nurses and nursing homes. These results are robust to institutional settings which employ pay-for-performance schemes (that reward either nursing homes or nurses): the two-sidedness of the market is strengthened and residents are still worse o¤.
We evaluate the impact of a price cap regulation implemented in the Colombian pharmaceutical mark... more We evaluate the impact of a price cap regulation implemented in the Colombian pharmaceutical market between 2011 and 2014. To do so, we take advantage of a unique data set where we observe three sources of variation: i) differences across eighteen groups in the Anatomical Therapeutic Chemical (ATC) classification system of the WHO, ii) the existence of regulated (treated) and unregulated (control) groups within each of these eighteen ATC groups, and iii) differences in time (before and after regulation) for the eighteen ATC groups. A triple differences model with fixed time effects and cluster errors is used to identify the impact of this regulation. We find that the price-cap regulation contributed to reduce prices in three of the eighteen groups and increase average prices for ten of them. We confirm then that the focal point effect generated by a price-cap regulation can generate unintended distortions. More specifically, our results reveal that the implementation of this price c...
We investigate the e¤ect of competition in the nursing homes sector with a two-sided market appro... more We investigate the e¤ect of competition in the nursing homes sector with a two-sided market approach. More precisely, we investigate the distributional implications across the three key actors involved (residents, nurses and nursing homes) that arise from the twosidedness of the market. Within a Hotelling set up, nursing homes compete for residents and for nurses, who provide quality to residents, by setting residents price and nurses wage. Nurses are assumed altruistic and therefore motivated to provide quality. The market is twosided because: i) a higher number of residents a¤ects nurses workload, which a¤ects their willingness to provide labour supply; and ii) a higher number of nurses a¤ects residents' quality through a better matching process and by relaxing nurses time constraints. Our key …ndings are that i) the two-sidedness of the market leads to higher wages for nurses, which makes the nurses better o¤; ii) this is then passed to residents in the form of higher prices, which makes residents worse o¤; iii) nursing homes pro…ts are instead una¤ected. In contrast, when nurses wages are regulated, the two-sidedness of the market implies a transfer between residents and nursing homes. When residents price are regulated, it implies a transfer between nurses and nursing homes. These results are robust to institutional settings which employ pay-for-performance schemes (that reward either nursing homes or nurses): the two-sidedness of the market is strengthened and residents are still worse o¤.
Las opiniones aquí expresadas son responsabilidad de los autores y por lo tanto no deben ser inte... more Las opiniones aquí expresadas son responsabilidad de los autores y por lo tanto no deben ser interpretadas como
En este artículo se estudia la posibilidad de introducir seguros de desempleo en Colombia.. En un... more En este artículo se estudia la posibilidad de introducir seguros de desempleo en Colombia.. En una primera parte, se propone una revisión de literatura de los seguros de desempleo en la cual se exponen las ventajas generadas por una cobertura contra este riesgo, así como sus inconvenientes. En una segunda parte, se estudian varios escenarios para introducir seguros de desempleo en Colombia. Después de haber presentado el contexto del mercado laboral y de las normas que lo vigilan, se proponen varios diseños que abordan la gestión y la administración del riesgo de desempleo en Colombia. Igualmente se presentan algunas consideraciones teóricas para la valoración del costo del aseguramiento, las cuales incorporan los efectos del riesgo moral sobre la duración y la incidencia del desempleo
The aim of this article is to estimate the type of selection that exists in the supplemental heal... more The aim of this article is to estimate the type of selection that exists in the supplemental health insurance market in Colombia where compulsory coverage is implemented through managed care competition. We build a panel database that combines individuals' information from the Ministry of Health and a database provided by two private health insurers. We perform the correlation test for consumption of health services frequency and supplemental coverage. Following Fang et al. (2008), we condition the estimation on health controls that are available to the econometrician but not to insurers. In both cases we obtain a positive correlation, suggesting that adverse selection predominates. In order to rule out some moral hazard effects, we estimate the correlation between previous frequency of healthcare service consumption and supplemental insurance purchase. The positive correlation obtained is robust to the inclusion of controls for diagnosis implemented by health insurers, suggesting that despite some risk selection strategies, they are not protected from adverse selection. We conclude that some subsidies to supplemental coverage purchase would lower public expenditure in Colombia.
Se analizan diferentes alternativas para la financiación de la educación superior, teniendo en cu... more Se analizan diferentes alternativas para la financiación de la educación superior, teniendo en cuenta que la presencia de fallas de mercado -tanto por el lado de la demanda como por el de la oferta-hace de éste un sector muy particular. Las primeras se relacionan con las decisiones privadas en términos de educación de la población estudiantil, y las segundas con las asimetrías de información que caracterizan el lado de la oferta en el financiamiento de la educación. El documento hace una revisión de literatura académica y de algunas experiencias internacionales sobre las diferentes fuentes de financiación en este sector, así como sus potenciales efectos sobre ciertas variables. Así, esta revisión arroja luces sobre las alternativas para el caso Colombiano.
This article examines a model of competition between two types of health insurer: Health Maintena... more This article examines a model of competition between two types of health insurer: Health Maintenance Organizations (HMOs) and nonintegrated insurers. HMOs vertically integrate health care providers and pay them at a competitive price, while nonintegrated health insurers work as indemnity plans and pay the health care providers freely chosen by policyholders at a wholesale price. Such difference is referred to as an input price effect which, at first glance, favors HMOs. Moreover, we assume that policyholders place a positive value on the provider diversity supplied by their health insurance plan and that this value increases with the probability of disease. Due to the restricted choice of health care providers in HMOs a risk segmentation occurs: policyholders who choose nonintegrated health insurers are characterized by higher risk, which also tends to favor HMOs. Our equilibrium analysis reveals that the equilibrium allocation only depends on the number of HMOs in the case of exclusivity contracts between HMOs and providers. Surprisingly, our model shows that the interplay between risk segmentation and input price effects may generate ambiguous results. More precisely, we reveal that vertical integration in health insurance markets may decrease health insurers' premiums.
... Prévision et de l'Analyse Economique, THEMA - 139, rue de Bercy - 75572 Paris Cedex 12 -... more ... Prévision et de l'Analyse Economique, THEMA - 139, rue de Bercy - 75572 Paris Cedex 12 - Tel : 01 53 18 86 27 - romain.lesur@dp ... Rice D., 1993, "Demand Curves, Economists and Deserts Islands: a re-sponse to Feldman and Dowd", Journal of Health Economics, 12, pp.201 ...
Se analizan diferentes alternativas para la financiación de la educación superior, teniendo en cu... more Se analizan diferentes alternativas para la financiación de la educación superior, teniendo en cuenta que la presencia de fallas de mercado -tanto por el lado de la demanda como por el de la oferta-hace de éste un sector muy particular. Las primeras se relacionan con las decisiones privadas en términos de educación de la población estudiantil, y las segundas con las asimetrías de información que caracterizan el lado de la oferta en el financiamiento de la educación. El documento hace una revisión de literatura académica y de algunas experiencias internacionales sobre las diferentes fuentes de financiación en este sector, así como sus potenciales efectos sobre ciertas variables. Así, esta revisión arroja luces sobre las alternativas para el caso Colombiano.
Dans le domaine de la santé, on utilise le terme de « risque moral » pour désigner le fait que le... more Dans le domaine de la santé, on utilise le terme de « risque moral » pour désigner le fait que les personnes assurées ont des dépenses de santé plus élevées que les personnes non assurées. Un article de Pauly en 1968 portant sur ce sujet a montré que le comportement ...
Nous proposons dans cet article une analyse qui se situe à l'intersection des problé... more Nous proposons dans cet article une analyse qui se situe à l'intersection des problématiques relatives aux comportements de risque moral et de la gestion des risques longs dans le secteur de l'assurance maladie. Un avantage comparatif est généralement attribué au système ...
Journal of Economics and Management Strategy, Feb 12, 2021
We investigate the e¤ect of competition in the nursing homes sector with a two-sided market appro... more We investigate the e¤ect of competition in the nursing homes sector with a two-sided market approach. More precisely, we investigate the distributional implications across the three key actors involved (residents, nurses and nursing homes) that arise from the twosidedness of the market. Within a Hotelling set up, nursing homes compete for residents and for nurses, who provide quality to residents, by setting residents price and nurses wage. Nurses are assumed altruistic and therefore motivated to provide quality. The market is twosided because: i) a higher number of residents a¤ects nurses workload, which a¤ects their willingness to provide labour supply; and ii) a higher number of nurses a¤ects residents' quality through a better matching process and by relaxing nurses time constraints. Our key …ndings are that i) the two-sidedness of the market leads to higher wages for nurses, which makes the nurses better o¤; ii) this is then passed to residents in the form of higher prices, which makes residents worse o¤; iii) nursing homes pro…ts are instead una¤ected. In contrast, when nurses wages are regulated, the two-sidedness of the market implies a transfer between residents and nursing homes. When residents price are regulated, it implies a transfer between nurses and nursing homes. These results are robust to institutional settings which employ pay-for-performance schemes (that reward either nursing homes or nurses): the two-sidedness of the market is strengthened and residents are still worse o¤.
We evaluate the impact of a price cap regulation implemented in the Colombian pharmaceutical mark... more We evaluate the impact of a price cap regulation implemented in the Colombian pharmaceutical market between 2011 and 2014. To do so, we take advantage of a unique data set where we observe three sources of variation: i) differences across eighteen groups in the Anatomical Therapeutic Chemical (ATC) classification system of the WHO, ii) the existence of regulated (treated) and unregulated (control) groups within each of these eighteen ATC groups, and iii) differences in time (before and after regulation) for the eighteen ATC groups. A triple differences model with fixed time effects and cluster errors is used to identify the impact of this regulation. We find that the price-cap regulation contributed to reduce prices in three of the eighteen groups and increase average prices for ten of them. We confirm then that the focal point effect generated by a price-cap regulation can generate unintended distortions. More specifically, our results reveal that the implementation of this price c...
We investigate the e¤ect of competition in the nursing homes sector with a two-sided market appro... more We investigate the e¤ect of competition in the nursing homes sector with a two-sided market approach. More precisely, we investigate the distributional implications across the three key actors involved (residents, nurses and nursing homes) that arise from the twosidedness of the market. Within a Hotelling set up, nursing homes compete for residents and for nurses, who provide quality to residents, by setting residents price and nurses wage. Nurses are assumed altruistic and therefore motivated to provide quality. The market is twosided because: i) a higher number of residents a¤ects nurses workload, which a¤ects their willingness to provide labour supply; and ii) a higher number of nurses a¤ects residents' quality through a better matching process and by relaxing nurses time constraints. Our key …ndings are that i) the two-sidedness of the market leads to higher wages for nurses, which makes the nurses better o¤; ii) this is then passed to residents in the form of higher prices, which makes residents worse o¤; iii) nursing homes pro…ts are instead una¤ected. In contrast, when nurses wages are regulated, the two-sidedness of the market implies a transfer between residents and nursing homes. When residents price are regulated, it implies a transfer between nurses and nursing homes. These results are robust to institutional settings which employ pay-for-performance schemes (that reward either nursing homes or nurses): the two-sidedness of the market is strengthened and residents are still worse o¤.
Las opiniones aquí expresadas son responsabilidad de los autores y por lo tanto no deben ser inte... more Las opiniones aquí expresadas son responsabilidad de los autores y por lo tanto no deben ser interpretadas como
En este artículo se estudia la posibilidad de introducir seguros de desempleo en Colombia.. En un... more En este artículo se estudia la posibilidad de introducir seguros de desempleo en Colombia.. En una primera parte, se propone una revisión de literatura de los seguros de desempleo en la cual se exponen las ventajas generadas por una cobertura contra este riesgo, así como sus inconvenientes. En una segunda parte, se estudian varios escenarios para introducir seguros de desempleo en Colombia. Después de haber presentado el contexto del mercado laboral y de las normas que lo vigilan, se proponen varios diseños que abordan la gestión y la administración del riesgo de desempleo en Colombia. Igualmente se presentan algunas consideraciones teóricas para la valoración del costo del aseguramiento, las cuales incorporan los efectos del riesgo moral sobre la duración y la incidencia del desempleo
The aim of this article is to estimate the type of selection that exists in the supplemental heal... more The aim of this article is to estimate the type of selection that exists in the supplemental health insurance market in Colombia where compulsory coverage is implemented through managed care competition. We build a panel database that combines individuals' information from the Ministry of Health and a database provided by two private health insurers. We perform the correlation test for consumption of health services frequency and supplemental coverage. Following Fang et al. (2008), we condition the estimation on health controls that are available to the econometrician but not to insurers. In both cases we obtain a positive correlation, suggesting that adverse selection predominates. In order to rule out some moral hazard effects, we estimate the correlation between previous frequency of healthcare service consumption and supplemental insurance purchase. The positive correlation obtained is robust to the inclusion of controls for diagnosis implemented by health insurers, suggesting that despite some risk selection strategies, they are not protected from adverse selection. We conclude that some subsidies to supplemental coverage purchase would lower public expenditure in Colombia.
Se analizan diferentes alternativas para la financiación de la educación superior, teniendo en cu... more Se analizan diferentes alternativas para la financiación de la educación superior, teniendo en cuenta que la presencia de fallas de mercado -tanto por el lado de la demanda como por el de la oferta-hace de éste un sector muy particular. Las primeras se relacionan con las decisiones privadas en términos de educación de la población estudiantil, y las segundas con las asimetrías de información que caracterizan el lado de la oferta en el financiamiento de la educación. El documento hace una revisión de literatura académica y de algunas experiencias internacionales sobre las diferentes fuentes de financiación en este sector, así como sus potenciales efectos sobre ciertas variables. Así, esta revisión arroja luces sobre las alternativas para el caso Colombiano.
This article examines a model of competition between two types of health insurer: Health Maintena... more This article examines a model of competition between two types of health insurer: Health Maintenance Organizations (HMOs) and nonintegrated insurers. HMOs vertically integrate health care providers and pay them at a competitive price, while nonintegrated health insurers work as indemnity plans and pay the health care providers freely chosen by policyholders at a wholesale price. Such difference is referred to as an input price effect which, at first glance, favors HMOs. Moreover, we assume that policyholders place a positive value on the provider diversity supplied by their health insurance plan and that this value increases with the probability of disease. Due to the restricted choice of health care providers in HMOs a risk segmentation occurs: policyholders who choose nonintegrated health insurers are characterized by higher risk, which also tends to favor HMOs. Our equilibrium analysis reveals that the equilibrium allocation only depends on the number of HMOs in the case of exclusivity contracts between HMOs and providers. Surprisingly, our model shows that the interplay between risk segmentation and input price effects may generate ambiguous results. More precisely, we reveal that vertical integration in health insurance markets may decrease health insurers' premiums.
... Prévision et de l'Analyse Economique, THEMA - 139, rue de Bercy - 75572 Paris Cedex 12 -... more ... Prévision et de l'Analyse Economique, THEMA - 139, rue de Bercy - 75572 Paris Cedex 12 - Tel : 01 53 18 86 27 - romain.lesur@dp ... Rice D., 1993, "Demand Curves, Economists and Deserts Islands: a re-sponse to Feldman and Dowd", Journal of Health Economics, 12, pp.201 ...
Se analizan diferentes alternativas para la financiación de la educación superior, teniendo en cu... more Se analizan diferentes alternativas para la financiación de la educación superior, teniendo en cuenta que la presencia de fallas de mercado -tanto por el lado de la demanda como por el de la oferta-hace de éste un sector muy particular. Las primeras se relacionan con las decisiones privadas en términos de educación de la población estudiantil, y las segundas con las asimetrías de información que caracterizan el lado de la oferta en el financiamiento de la educación. El documento hace una revisión de literatura académica y de algunas experiencias internacionales sobre las diferentes fuentes de financiación en este sector, así como sus potenciales efectos sobre ciertas variables. Así, esta revisión arroja luces sobre las alternativas para el caso Colombiano.
Dans le domaine de la santé, on utilise le terme de « risque moral » pour désigner le fait que le... more Dans le domaine de la santé, on utilise le terme de « risque moral » pour désigner le fait que les personnes assurées ont des dépenses de santé plus élevées que les personnes non assurées. Un article de Pauly en 1968 portant sur ce sujet a montré que le comportement ...
Nous proposons dans cet article une analyse qui se situe à l'intersection des problé... more Nous proposons dans cet article une analyse qui se situe à l'intersection des problématiques relatives aux comportements de risque moral et de la gestion des risques longs dans le secteur de l'assurance maladie. Un avantage comparatif est généralement attribué au système ...
Countries that seek to provide universal health coverage deal with considerable publicly funded e... more Countries that seek to provide universal health coverage deal with considerable publicly funded expenses. This article discusses if a private health insurance subsidy policy can reduce the expenses covered by the public system. A theoretical model is developed in which individuals are characterized by two dimensions: inherited risk of illness and preferences for prevention activities. It is shown that when beneficiaries of a voluntary plan have lower risk, i.e. advantageous selection scenario, a subsidy raises heath expenses if articulation between coverage is complementary. On the contrary, in adverse selection scenarios a subsidy reduces expenditure if articulation is supplementary. Intermediate scenarios are also considered where articulations between coverages have both complementary and supplementary components, which is apparently the case for the Colombian health system. Calibrated numerical simulations are provided using the Colombian system data. The calibration strategy employed reveals that selection is adverse in the Colombian voluntary health insurance market. Furthermore, we identify the level of subsidy and changes in articulation towards supplementarity that could lead to a reduction in public spending.
The aim of this article is to estimate the type of selection that exists in the voluntary health ... more The aim of this article is to estimate the type of selection that exists in the voluntary health insurance market in Colombia where the compulsory coverage is implemented through a managed care competition. We build a panel database that combines individuals' information from the Ministry of Health and a database provided by two private health insurers. We perform the correlation test for health expenditure and coverage. Following Fang et al. , we condition the estimation on health controls that are available to the econometrician but not to insurers. In both cases we obtain a positive correlation, suggesting that adverse selection predominates. In order to rule out some moral hazard effects, we estimate the correlation between previous health service consumption and insurance purchase. The positive correlation obtained is robust to the inclusion of controls for diagnosis, suggesting that despite some risk selection strategies, health insurers are not protected from adverse selection.
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