INVESTIGADORES
ELORZA Maria Eugenia
congresos y reuniones científicas
Título:
Optimal mechanism design for health care systems in developing countries: gatekeeping vs co-payments
Autor/es:
VIRDIS JUAN MARCELO; MARIA EUGENIA ELORZA; FERNANDO DELBIANCO
Lugar:
Berkeley
Reunión:
Workshop; 4th Workshop on Mechanism Design for Social Good (MD4SG '20); 2020
Resumen:
The gatekeeping is a strategy used in several public and private health systems in order toreduce health care costs which had raised dramatically in the second half of the twentiethcentury and, simultaneously, to promote primary health care. Unlike the copayment, whichhas been universally used to reduce costs of health care, the gatekeeping is a nonprice costcontainment mechanism.More specifically, in developing economies the copayment creates a barrier to health careaccess for low-income people. Therefore, in an inequal income context, nonprice mechanismslike gatekeeping, are the correct approach for cost containment and primary care promotion.However, to examine precisely costs and benefits from pricing and nonprice mechanism in thatcontext, a specific theoretical framework must be developed.This position paper proposes a theoretical approach to discuss the issues that must be takeninto account for health mechanism design in a high-poverty context. The first section describesthe evolution of health care spending, copayments and gatekeeping. The second sectiondescribes theoretically the effectiveness of pricing mechanism in an inequal income context.In conclusion, when the gatekeeping strategy is chosen the adverse selection issue describedpreviously will be replaced for a moral hazard problem. A still unsolved question is which effectis more costly to the health system. In the asymmetric information case blended with incomeinequalities, the gatekeeping system will be more useful. Even though new agency problemsbetween the insurer and the physician will be added, the latter altruistic component will beuseful to prevent unnecessary specialist visits