Essays on health care financing and health services.

Summary The world spends a significative and steadily increasing share of its resources on health care. Debates about health care financing models and practitioner payment methods are taking place around the world. Nevertheless, there is still no consensus on the ideal choice of financing mechanisms. This thesis aims to contribute to the debates on health care financing and health services policy. Chapter 1 examines the optimal nonlinear practitioner compensation rule, the principle under pay-for-performance, fee-for-service, and capitation in the presence of both adverse selection and moral hazard at the offre level. We found that when moral hazard is the only problem, fee-for-service can only lead to substitution of treatment quantity for practitioner effort, which is inefficient. As a result, fee-for-service payment should not be used in this case. However, when moral hazard combines with the problem of adverse selection, efficacious screening requires continued use of the fee-for-service system for low-productivity practitioners and less use of the pay-for-performance system. The development of payment utilization improves screening. We provide arguments on critical analysis of fee-for-service weaknesses. And, most importantly, we establish the reasons for the continued use of fee-for-service despite the fact that serious problems with the system have been widely recognized. Chapter Two analyzes the problem of the trilateral contract between payer, patient, and practitioner, where the practitioner and patient can agree to exploit mutually beneficial opportunities. Assuming that a secondary transfer between the patient and the practitioner is excluded, we analyze the problem of setting up the mechanism where the practitioner and the patient submit the diagnosis claim to the payer through a declaration game. We also derive the optimal insurance and payment scheme for the patient and practitioner. The optimal scheme of insurance and payment that is collusion-proof (weak) is such that one of the two tells the truth . but the payer's trade-off is different depending on the different ways it chooses to allocate incentives between the patient and the practitioner. Furthermore, we show that if the payer is successful in having both parties present the diagnosis sequentially, the advantage of the second agent's veto power allows the payer to achieve the best outcome. My secondary area of study deals with development economics. The third chapter aims to examine whether migration from villages to cities leads to a crowding out of informal risk-sharing contracts and leads households to less (self-)insurance for consumption in Thai villages. In terms of theoretical motivation, our idea is that migration can be used as an investment contract made in advance between the household and the child. The household invests by paying in advance in exchange for future payments depending on circumstances, which changes the household income process. For estimation, we used the Townsend Thai Annual Surveys (1997-2010) table. The hypothesis of no selection bias is rejected at the village insurance market level, supporting our conjecture that migration changes the risk-sharing status of households within the village. When biases are corrected, our results show that migration leads to crowding out of informal risk sharing in the village and even leads to a decrease in Thai households' consumption (self-)insurance.