TY - JOUR

T1 - Overcoming resistance against managed care

T2 - insights from a bargaining model

AU - Ehlert, Andree

AU - Wein, Thomas

AU - Zweifel, Peter

PY - 2017/5/22

Y1 - 2017/5/22

N2 - Recent healthcare reforms have sought to increase efficiency by introducing managed care (MC) while respecting consumer preferences by admitting choice between MC and conventional care. This article proposes an institutional change designed to let German consumers choose between the two settings through directing payments from the Federal Health Fund to social health insurers (SHIs) or to specialized MC organizations (MCOs). To gauge the chance of success of this reform, a game involving a SHI, a MCO, and a representative insured (RI) is analyzed. In a “three-player/three-cake” game the coalitions {SHI, MCO}, {MCO, RI}, and {SHI, RI} can form. Players’ possibility to switch between coalitions creates new outside options, causing the conventional bilateral Nash bargaining solution to be replaced by the so-called von Neumann-Morgenstern triple. These triples are compared to the status quo (where the RI has no threat potential) and related to institutional conditions characterizing Germany, the Netherlands, and Switzerland.

AB - Recent healthcare reforms have sought to increase efficiency by introducing managed care (MC) while respecting consumer preferences by admitting choice between MC and conventional care. This article proposes an institutional change designed to let German consumers choose between the two settings through directing payments from the Federal Health Fund to social health insurers (SHIs) or to specialized MC organizations (MCOs). To gauge the chance of success of this reform, a game involving a SHI, a MCO, and a representative insured (RI) is analyzed. In a “three-player/three-cake” game the coalitions {SHI, MCO}, {MCO, RI}, and {SHI, RI} can form. Players’ possibility to switch between coalitions creates new outside options, causing the conventional bilateral Nash bargaining solution to be replaced by the so-called von Neumann-Morgenstern triple. These triples are compared to the status quo (where the RI has no threat potential) and related to institutional conditions characterizing Germany, the Netherlands, and Switzerland.

KW - Health sciences

KW - Consumer choice

KW - Game theory

KW - Germany

KW - Health insurance

KW - Healthcare reform

KW - Managed care

KW - Multilateral Nash bargaining

KW - Switzerland

KW - The Netherlands

UR - http://www.scopus.com/inward/record.url?scp=85019643230&partnerID=8YFLogxK

UR - https://www.mendeley.com/catalogue/f1696c2b-aba2-3eea-9773-7523092b5d82/

U2 - 10.1186/s13561-017-0156-4

DO - 10.1186/s13561-017-0156-4

M3 - Journal articles

C2 - 28534279

AN - SCOPUS:85019643230

VL - 7

JO - Health Economics Review

JF - Health Economics Review

SN - 2191-1991

IS - 1

M1 - 19

ER -