Nature of Competition and Regulation in Health Care Markets : Implications for Public Policy

보건의료분야에서의 경쟁과 규제의 본질 : 공공정책적 함의

  • 권순만 (한국외국어대학교 정책과학대학)
  • Published : 1996.11.01

Abstract

On rationale for government intervention is the failure of competition in the market. Health care markets are characterized by such unique aspects as information asymmetry, prevalence of insurance, and cost-increasing competition based on the adoption of costly medical technology. Therefore, government policy to guarantee a sufficient number of providers in markets may not lead to socially beneficisal outcomes such as higher quantity and lower price. This paper examines the unique nature of health services and its implications for competition, the evidence that competition may not reduce health care ex[enditures, and policy tools that government can use to encourage competition which contributes to supporting a sustainable health care system.

민간 시장에서의 경쟁의 실패는 일반적으로 정부개입과 규제의 대표적인 근거를 제공한다. 하지만 보건의료분야는 정보의 비대칭성, 의료보험의 보편화, 고가의료기술 및 장비에 의한 비용상승 등과 같은 특수성으로 인하여, 정부가 단순히 충분한 의료공급자나 병원의 수를 보장함으로써 가격의 하락과 서비스 양의 증가와 같은 경쟁의 효과를 기대하기 힘들다. 본 논문은 경쟁과 규제와 관련한 보건의료의 특수성과, 보건의료분야에서 경쟁이 소비자 후생에 미치는 영향에 관한 이론 및 실증분석의 결과들을 고찰한다. 나아가 경쟁과 규제가 조화된 지속가능한(sustainable) 보건의료체계를 위해, 병원설비투자의 직접적인 규제로부터 규제를 통해 경쟁을 촉진시키는 인센티브규제(incentive regulation)로서의 지불보상제도 그리고 필요한 정보의 제공을 통한 시장기능의 회복에 이르는, 정부가 집행할 수 있는 효과적인 정책도구들을 분석한다.

Keywords

References

  1. Rand Journal of Economics v.18 no.4 Monitoring, moral hazard, asymmetric information and risk sharing in procurement contracting Baron, D.;D. Besanko
  2. Rand Journal of Economics v.22 no.1 The interaction between forms of insurance contract and types of technological change in medical care Baumgardner, J.
  3. Health Care Financing Review Medicare's prospective payment system: a critical appraisal Coulam, R.;G. Gaumer
  4. Journal of Health Economics v.5 Physician-induced demand for surgery Cromwell, J.;J. Mitchell
  5. Economic Inquiry v.26 Demand inducement and the physician / patient relationship Dranove, D.
  6. Journal of Health Economics v.8 A note on the relational aspects of hospital market deficitions Dranove, D.;M. Shanley
  7. Rand Journal of Economics v.23 no.2 Is hospital competition wasteful? Dranove, D.;M. Shanley;C. Simon
  8. Journal of Law and Economics v.36 Price and concentration in hospital market s : the swith from patient-driven to payer-driven competition Dranove, D.;M. Shanley;W. White
  9. Journal of Health Economics v.9 Optimal payment systems for health services Ellis, R.;T. McGuire
  10. Inquiry v.29 Explaining the association between surgeon supply and utilization Escarce, J.
  11. Journal of Health Economics v.9 Effects of HMOs on the creation of competitive markets for hospital services Feldman, R.;H. Chan;J. Kralewski;B. Dowd;J. Shapiro
  12. Journal of Human Resources v.13 The supply of surgeons and the demand for operations Fuchs, V.
  13. Journal of Health Politics, Policy and Law v.16 Interest groups or the public interest -why do we regulate health occupations? Graddy, E.
  14. Econometrica v.51 no.1 An analysis of the principal-agent problem Grossman, S.;O. Hart
  15. Inquiry v.26 Profits and fiscal pressure in the prospective payment system: their impacts on hospitals Hadley, J.;S. Zuckerman;J. Feder
  16. New England Journal of Medicine v.321 How do financial incentives affect physicians' clinical decisions and the financial performance of health maintenance organizations Hillman, A.;M. Pauly;J. Kerstein
  17. Bell Journal of Economics v.10 no.1 Moral hazard and observability Holmstrom, B.
  18. Bell Journal of Economics v.13 Moral hazard in teams Holmstrom, B.
  19. Bell Journal of Economics v.11 The effects of competition and regulation on hospital bed supply and the reservation quality of the hospital Joskow, P.
  20. A New Approaches to the Economics of Health Care Alternative regulatory mechanisms for controlling hospital costs Joskow, P.;M. Olsen(ed.)
  21. Unpublished Doctoral Dissertation, The University of Pennsylvania A Theory of Incentives for Providers: Payment Systems, Quality of Services, and Consumer Information in Health Care Markets Kwon, S.
  22. Medical care Research and Review v.53 no.2 Structure of financial incentive systems for provides in managed care plans Kwon, S.
  23. Journal of Risk and Insurance Consumer choice of provider payment systems in health insurance markets Kwon, S.
  24. Journal of Political Economy v.94 Using cost observation to regulate firms Laffont, J.-J.;J. Tirole
  25. Journal of Health Economics v.8 Rejoinder to Dranove and Shanley Luft, H.;C. Phibbs;D. Garnick;J. Robinson
  26. Inquiry v.23 The role of specialized clinical services in competition among hospitals Luft, H.;J. Robinson;D. Garnick;S. Maerki;S. McPhee
  27. Journal of Health Economics v.4 The competitive nature of primary care physician services market McCarthy, T.
  28. Journal of Health Economics v.10 Physician response to fee changes with multiple payers McGuire, T.;M. Pauly
  29. Journal of Health Economics v.11 The effects of market structure and bargaining position on hospital prices Melnick, G.;J. Zwanziger;A. Bamezai;R. Pattison
  30. American Economic Review v.60 no.1 Toward a theory of nonprofit institutions: an economic model of a hospital Newhouse, J.
  31. Journal of Economic Perspectives v.6 no.3 Medical care costs: how much welfare loss? Newhouse, J.
  32. Journal of Health Economics v.7 Competition among hospitals Noether, M.
  33. Financing and Delivering Health Care: A comparative Analysis of OECD Countries Organization for Economic Cooperation and Development
  34. Doctors and Their Workshops Pauly, M.
  35. Journals of Economic Literature v.24 Taxation, health insurance, and market failure in the medical economy Pauly, M.
  36. American Economic Review v.63 no.1 The not-for-profit hospital as a physicians' cooperative Pauly, M.;M. Redisch
  37. Bell Journal of Economics v.12 The pricing of primary care physicians' services: a test of the role of consumer information Pauly, M.;M. Satterthwaite
  38. Journal of Law and Economics v.19 Toward a more general theory of ragulation Peltzman, S.
  39. Journal of Health Economics v.5 Induced demand -can we ever know its extent? Phelps, C.
  40. Journal of Economic Perspectives v.6 Diffusion of information in medical care Phelps, C.
  41. Journal of Health Economics v.4 The impact of hospital market structure on patient volume, average length of stay, and the cost of care Robinson, J.;H. Luft
  42. Bell Journal of Economics v.10 Consumer information, equilibrium industry price, and the number of sellers Satterthwaite, M.
  43. Rand Journal of Economics v.16 no.3 A theory of yardstick competition Shleifer, A.
  44. Journal of Law and Economics v.23 no.1 Effects of regulation on hospital costs and input use Solan, F.;B. Steinwald
  45. Bell Journal of Economics v.2 The theory of economic regulation Stigler, G.
  46. Imperfect information in the product market Stiglitz, J.;R. Schmalensee(ed.);R. Willig(ed.)
  47. Journal of Health Economics v.9 Regulatory intensity and hospital cost growth Thorpe, K.;C. Phelps
  48. The Theory of Industrial Organization Tirole, J.
  49. Journal of Economic Literature v.29 The health care quadrilemma: an essay on technological change, insurance, quality of care, and cost containment Weisbrod, B.
  50. Health Affairs v.3 Dealing with medical practice variations: a proposal for action Wennberg, J.
  51. Journal of Economic Theory v.2 Medical insurance: a case study of the tradeoff between risk-spreading and appropriate incentives Zeckhauser, R.
  52. Journal of Health Economics v.7 The effects of hospital competition and the medicars PPS program on hospital cost behavior in California Zwanziger, J.;G. Melnick