Nonresponsiveness, Severity Auditing, and Upcoding Deterrence
| Autor: | Florence Naegelen, Michel Mougeot |
|---|---|
| Přispěvatelé: | Centre de REcherches sur les Stratégies Economiques (UR 3190) (CRESE), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre de REcherches sur les Stratégies Economiques (EA 3190) (CRESE) |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Economics and Econometrics
Actuarial science Mechanism (biology) musculoskeletal neural and ocular physiology media_common.quotation_subject Intensive treatment 05 social sciences Adverse selection macromolecular substances Audit Group system [SHS.ECO]Humanities and Social Sciences/Economics and Finance nervous system 0502 economics and business 050206 economic theory Deterrence theory Business 050207 economics Function (engineering) ComputingMilieux_MISCELLANEOUS media_common Drawback |
| Zdroj: | Journal of Institutional and Theoretical Economics Journal of Institutional and Theoretical Economics, Mohr Siebeck, In press, ⟨10.1628/jite-2018-0011⟩ |
| ISSN: | 0932-4569 |
| Popis: | In many countries, the diagnosis-related group system has been expanded to address patient severity. This paper highlights a fundamental drawback of any price refinement policy under adverse selection. Without auditing, no mechanism such that high-severity patients receive more intensive treatment than low-severity patients can ensure that providers are deterred from upcoding. In contrast, we show that splitting can be implemented if the regulator designs an auditing mechanism when the proportion of low-severity patients is sufficiently high. The optimal level of services increases with severity under conditions depending on the net social benefit function and on the cost function. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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