Discontinuous system of allowances: The response of prosocial health-care professionals
Discontinuous system of allowances: The response of prosocial health-care professionals
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不连续的津贴制度：亲社会医疗保健专业人员的反应
DOI：
10.1016/j.jpubeco.2020.104248
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发表时间：
2020
影响因子：
9.8
通讯作者：
Hernández-Pizarro H
中科院分区：
文献类型：
--
作者：
Hernández-Pizarro H
本文研究了公共政策中非线性激励的意外战略效应。分成离散区间的医疗保健补贴制度可能会导致战略行为。我们提供了关于这个问题的新证据，重点关注医疗保健提供者 (HCP) 采取战略行动的案例。我们表明，HCP 会调整索赔人在长期护理需求评估中的分数，从而使索赔人能够获得更高水平的护理福利。此次调整不会给 HCP 带来任何金钱收益。在准自然的实验环境中——西班牙长期护理 (LTC) 的实施——我们表明，索赔人的需求分布包括围绕长期护理系统设定的阈值的扭结。这些问题表明，医疗保健提供者采取亲社会行为，帮助索赔人获得更高水平的福利，而不会因健康状况、居住地或性别而歧视。通过开发一个新的非参数估计器，我们证明这些调整增加了公共 LTC 支出，这相当于将阈值向左移动。每个调整后的索赔人每年的额外费用平均约为 1000 欧元。最后，我们还通过利用消除某些阈值的改革，实证探索阈值的数量是否会影响这种行为。我们发现阈值数量的减少与围绕剩余阈值的调整增加相关。
This paper examines the unintended strategic effects of non-linear incentives in public policies. A system of health care subsidies structured into discrete intervals may lead to strategic behaviour. We provide new evidence on this issue, focusing on a case where strategic actions are taken by healthcare providers (HCPs). We show that HCPs adjust the score of claimants in long-term care needs assessments, allowing claimants to access higher levels of care benefits. This adjustment does not bring any pecuniary gain for HCPs. In a quasi-natural experimental setting –the implementation of Spanish long-term care (LTC)– we show that the distribution of the claimants' needs includes kinks around the thresholds set for the LTC system. These kinks reveal that healthcare providers adopt prosocial behaviour, helping claimants jump to a higher level of benefits without discriminating by health status, residence, or gender. By developing a new non-parametric estimator, we prove that these adjustments increase the public LTC spending, which is equivalent to moving thresholds to the left. The additional cost per adjusted claimant per annum is approximately 1000 euro on average. Finally, we also explore empirically whether the number of thresholds could affect such behaviour, by exploiting a reform that eliminated some thresholds. We find that the lower number of thresholds is associated with an increase of adjustment around the thresholds that remain.
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DOI：
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