Competition Between Hospitals Under Bundled Payments and Fee-for-Service: An Equilibrium Analysis of Insurer’s Choice
Published Online:19 Jan 2022https://doi.org/10.1287/msom.2021.1039
References
- (2017) Bundled payment vs. fee-for-service: Impact of payment scheme on performance. Management Sci. 63(5):1606–1624.Link, Google Scholar
- American Hospital Association (2017) Fact sheet: Hospital billing explained. Accessed October 29, 2020, https://www.aha.org/system/files/2018-01/factsheet-hospital-billing-explained-9-2017.pdf.Google Scholar
- America’s Health Insurance Plans (AHIP) (2018) Ask the AHIP experts: Why provider networks are important. Accessed October 29, 2020, https://www.ahip.org/ask-the-ahip-experts-why-provider-networks-are-important/.Google Scholar
- (2011) Competing for low-end markets. Marketing Sci. 30(5):776–788.Link, Google Scholar
- (2015) Competition and the operational performance of hospitals: The role of hospital objectives. Production Oper. Management 24(11):1812–1832.Crossref, Google Scholar
- (2013) The impact of cross-border patient movement on the delivery of healthcare services. Internat. J. Production Econom. 145(2):702–712.Crossref, Google Scholar
- (2014) Introducing competition in healthcare services: The role of private care and increased patient mobility. Eur. J. Oper. Res. 234(3):898–909.Crossref, Google Scholar
- (2018) Incentive programs for reducing readmissions when patient care is co-produced. Production Oper. Management 27(6):999–1020.Crossref, Google Scholar
- (2016) A more detailed understanding of factors associated with hospital profitability. Health Affairs 35(5):889–897.Crossref, Google Scholar
- (2019) Price Setting and Price Regulation in Healthcare: Lessons for Advancing Universal Health Coverage (World Health Organization, Geneva).Crossref, Google Scholar
- (2016) Analysis of medicare pay-for-performance contracts. Preprint, submitted September 15, 2016, https://dx.doi.org/10.2139/ssrn.2839143.Google Scholar
- (1995) Competition and specialization in the hospital industry: An application of Hotelling’s location model. Southern Econom. J. 61(4):1182–1198.Crossref, Google Scholar
- (2006) Quality-based competition, profitability, and variable costs. Management Sci. 52(12):1884–1895.Link, Google Scholar
- (2016) Healthcare exceptionalism? Performance and allocation in the US healthcare sector. Amer. Econom. Rev. 106(8):2110–2144.Crossref, Google Scholar
- Community Health Choice (2016a) A process for structuring bundled payments in maternity care. Accessed on October 29, 2020, https://catalyst.nejm.org/bundled-payments-maternity-care/.Google Scholar
- Community Health Choice (2016b) Bundles of joy? How new payment models for maternal care could deliver lower costs. Accessed October 29, 2020, http://www.modernhealthcare.com/article/20160813/MAGAZINE/308139965.Google Scholar
- (2002) Hospital market structure and the behavior of not-for-profit hospitals. RAND J. Econom. 33(3):433–446.Crossref, Google Scholar
- (1998) Creaming, skimping and dumping: Provider competition on the intensive and extensive margins. J. Health Econom. 17(5):537–555.Crossref, Google Scholar
- (2004) Use of quality adjusted life years and life years gained as benchmarks in economic evaluations: A critical appraisal. Health Care Management Sci. 7(1):43–49.Crossref, Google Scholar
- (2019) The impact of reimbursement policy on social welfare, revisit rate and waiting time in a public healthcare system: Fee-for-service vs. bundled payment. Manufacturing Service Oper. Management 21(1):154–170.Link, Google Scholar
- (2015) Bundled payments for healthcare services: Proposer selection and information sharing. Oper. Res. 63(4):772–788.Link, Google Scholar
- HCPLAN (2016) Clinical episode payment integrated white paper. Accessed October 29, 2020, https://hcp-lan.org/workproducts/cep-whitepaper-final.pdf.Google Scholar
- (2014) Note on bundled payment in healthcare. Harvard Business School Background Note 312-032, September 2011. (Revised August 2014.)Google Scholar
- (1997) Choice of long-term strategy for the management of patients with severe esophagitis: A cost-utility analysis. Gastroenterology 112(4):1078–1086.Crossref, Google Scholar
- HHS (2016) Examples of health care payment models being used in the public and private sectors. Accessed October 29, 2020, https://aspe.hhs.gov/system/files/pdf/208761/ExamplesHealthCarePaymentModels.pdfGoogle Scholar
- (2005) Making profits and providing care: Comparing nonprofit, for-profit, and government hospitals. Health Affairs 24(3):790–801.Crossref, Google Scholar
- HRRP (2012) Hospital Readmissions Reduction Program. Accessed October 29, 2020, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.Google Scholar
- (2014) Vertical integration under competition: Forward, backward, or no integration? Production Oper. Management 23(1):19–35.Crossref, Google Scholar
- (2021) Does competition improve service quality? The case of nursing homes where public and private payers coexist. Management Sci. 67(10):6493–6512.Google Scholar
- (2018) Evaluation of Medicare’s bundled payments initiative for medical conditions. New England J. Medicine 379(3):260–269.Crossref, Google Scholar
- (1988) Product and price competition in a duopoly. Marketing Sci. 7(2):141–168.Link, Google Scholar
- (2000) Are pharmaceuticals cost-effective? A review of the evidence. Health Affairs 19(2):92–109.Crossref, Google Scholar
- NHE Fact Sheet (2018) NHE Fact Sheet. Accessed October 29, 2020, https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html.Google Scholar
- (2016) How to pay for health care. Harvard Bus. Rev. 94(7–8):88–98.Google Scholar
- (2009) How do hospitals get paid? A primer. New York Times. https://economix.blogs.nytimes.com/2009/01/23/how-do-hospitals-get-paid-a-primer/.Google Scholar
- (2015) Can hospitals compete on quality? Health Care Management Sci. 18(3):376–388.Crossref, Google Scholar
- (2017) Why GE, Boeing, Lowe’s, and Walmart are directly buying healthcare for employees. Harvard Bus. Rev. web article, reprint No. H03PR2, Published on hbr.org, June 8, 2017. https://hbr.org/2017/06/why-ge-boeing-lowes-and-walmart-are-directly-buying-health-care-for-employees.Google Scholar
- UnitedHealthcare (2016) UnitedHealthcare expands bundled payments for orthopedics. Accessed October 29, 2020, http://www.modernhealthcare.com/article/20161201/NEWS/161209999.Google Scholar
- (2020) The business of healthcare: The role of physician integration in bundled payments. Preprint, submitted February 17, https://dx.doi.org/10.2139/ssrn.3539596.Google Scholar
- (1988) The Nonprofit Economy (Harvard University Press, Cambridge, MA).Crossref, Google Scholar
- (2016) Hospital readmissions reduction program: An economic and operational analysis. Management Sci. 62(11):3351–3371.Link, Google Scholar
- (2016) Fee-for-service, while much maligned, remains the dominant payment method for physician visits. Health Affairs 35(3):411–414.Crossref, Google Scholar

