Gatekeeper incentives and demand inducement: An empirical analysis of care managers in the Japanese long-term care insurance program
Gatekeeper incentives and demand inducement: An empirical analysis of care managers in the Japanese long-term care insurance program
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DOI：
10.1016/j.jjie.2016.03.001
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发表时间：
2016-06-01
影响因子：
2.9
通讯作者：
Nakamura, Jiro
中科院分区：
文献类型：
--
作者：
Sugawara, Shinya;Nakamura, Jiro
本研究分析日本长期照护社会保险计划中，作为消费者与服务提供者之间的中介，照护管理者的激励与供应商诱导需求。护理管理人员可以被视为纯粹的看门人，因为他们的功能仅限于将人们转介给专家，而他们自己并不提供护理。护理经理按人头支付报酬，这被认为是保险公司具有成本效益的支付机制。然而，许多护理经理实际上也为提供服务的公司工作。服务提供者通过按服务付费获得奖励，并可能有动机诱导过度的消费者需求。违反护理管理人员的中立性可能导致社会保险的财政负担。在本研究中，我们实证检验护理管理者密度与护理成本之间是否存在正相关关系，这可能暗示了供应商诱导需求的存在。我们的研究结果显示出正相关，特别是在为服务提供部门联合运营的公司工作的护理经理的情况下。基于这些结果，我们进行了定量分析，并表明护理经理诱导的需求可能会对社会保险产生相当大的经济负担。(C) 2016 Elsevier Inc.版权所有。
This study analyzes the incentives and supplier-induced demand of care managers, who are intermediaries between consumers and service providers in the Japanese social insurance program for long-term care. Care managers can be considered as pure gatekeepers, in that their function is limited to referral people to specialists and they themselves do not provide care. Care managers are rewarded by capitation, which is considered as a cost-effective payment mechanism for insurers. However, many care managers actually work for firms that also operate as service providers. Service providers are rewarded by a fee for-service payment and can have a motivation to induce excess consumer demand. The violation of the neutrality of care managers might result in a financial burden on social insurance. In this study, we empirically test whether there is a positive correlation between care manager density and care costs, which might imply the existence of supplier-induced demand. Our results show a positive correlation, particularly in the case of care managers who work for firms that jointly operate in service provision sectors. Based on these results, we conduct a quantitative analysis, and show that the demand induced by care managers might produce a considerable financial burden on social insurance. (C) 2016 Elsevier Inc. All rights reserved.