Quality incentives in a regulated market with imperfect information and switching costs: capitation in general practice

We model a system akin to the British National Health Service (NHS), in which general practictioners (GPs) are paid by capitation from general taxation. GPs are horizontally and vertically differentiated and compete for patients via their imperfect observed quality. We show that for any given capitation fee quality is lower and the incentive effects of the fee on quality are smaller when there is imperfect information. There are diminishing welfare gains from improving patient information but increasing welfare gains from reducing switching costs. GPs do not act efficiently to improve patient information via advertising or to reduce the costs of switching.     

Controlling illegal stimulants: a regulated market model

Prohibition of illegal drugs is a failed social policy and new models of regulation of these substances are needed. This paper explores a proposal for a post-prohibition, public health based model for the regulation of the most problematic drugs, the smokable and injectable stimulants. The literature on stimulant maintenance is explored. Seven foundational principles are suggested that could support this regulatory model of drug control that would reduce both health and social problems related to illegal stimulants. Some details of this model are examined and the paper concludes that drug policies need to be subject to research and based on evidence.     

Hospital quality choice and market structure in a regulated duopoly

This paper analyzes the optimal structure of a regulated health care industry in a model in which the regulator cannot enforce what hospitals do (unverifiable quality of health) or does not know what hospitals know (incomplete information about production costs) or both. We show that if quality is unverifiable the choice between monopoly and duopoly does not change with respect to the verifiable case but, if there are fixed costs (assumed to be quality dependent) and the monopoly is the optimal market structure, the quality level of the operative hospital decreases. Asymmetry of information introduces informational rents that can be reduced by increasing the most efficient hospital's market share. A monopoly is chosen more often.     

Technology acquisition in Canada. Control in a regulated market.

The authors provide a detailed overview of how the national and provincial health systems of Canada exercise control over the diffusion of medical technology. In particular, they examine the diffusion of CT scanning and the adoption of non-ionic radio contrast media. While the nature of the parliamentary system theoretically allows the government, especially the executive, to exert more control over its policy agenda than in the United States, the authors believe that effective control is hampered by a lack of political will and insufficient "teeth" in the Ministry of Health's mandate and policy. The authors also conclude that the manipulation of reimbursement systems to encourage or discourage the diffusion of various medical technologies is not always effective, and that political clout often triumphs over rational decision making.     

Roadside sobriety tests and attitudes toward a regulated cannabis market

Background  

Many argue that prohibition creates more troubles than alternative policies, but fewer than half of American voters support a taxed and regulated market for cannabis. Some oppose a regulated market because of concerns about driving after smoking cannabis. Although a roadside sobriety test for impairment exists, few voters know about it. The widespread use of a roadside sobriety test that could detect recent cannabis use might lead some voters who currently oppose a regulated market to support it. In contrast, a question that primes respondents about the potential for driving after cannabis use might lead respondents to be less likely to support a regulated market.     

Centrelink forms -- a guide for GPs

Centrelink is a Commonwealth Government agency that delivers payments and services to the Australian community. This article highlights the range of forms general practitioners are commonly asked to complete for Centrelink clients and provides tips on accurate completion of these forms. This article is based on information outlined in the Centrelink factsheet 'Helpful information for medical practitioners: Centrelink medical report - Disability Support Pension' and on the Centrelink and Department of Families, Housing, Community Services and Indigenous Affairs website. The information contained within this article has been checked for accuracy by Centrelink.     

Objectives, information and incentives in the NHS internal market.

In order to achieve and monitor success in the NHS internal market, it is important that information related to health care objectives is developed and used. The paper argues that these objectives are not always easy to specify but that four groups can be identified: efficiency, equity, quality and accountability/responsiveness. Although information management specialists have emphasised the construction and use of appropriate frameworks for planning information flows, whether appropriate information is used depends on the existence of incentives for its supply. Using concepts from game theory, the paper offers a non-technical examination of the incentives that the contracting environment imposes on the development of new information. The article concludes by suggesting that, for a variety of reasons, the incentives to produce information which would help monitor medical outcomes and related objectives, as distinct from inputs or activities, are often weak and sometimes perverse.     

Family law matters - a guide for GPs

BACKGROUND: General practitioners are regularly called upon to assist their patients in family law disputes. They are often served with a subpoena to produce their patient's file, or that of their children, and can be called upon to provide short reports regarding various health conditions of their patients. Doctors can also sometimes become witnesses in family law litigation and the time needed to participate is rarely compensated. OBJECTIVE This article aims to provide GPs with key information in relation to responding to a subpoena and the preparation of reports in family law matters. DISCUSSION: Careful preparation of subpoenas and reports by GPs who find themselves embroiled in the family law disputes of their patients can save significant time and costs to all involved.     

Fitness to drive forms - a guide for GPs

The effect of medical conditions on fitness to drive and crash risk has long been recognised. Therefore doctors and other health professionals play an important role in public health and safety when advising patients about fitness to drive and when providing information to driver licensing authorities to support their decision making in this regard. Various forms support communication between the doctor, patient and driver licensing authority.