[Financial incentives to achieve health-related behavioral goals: State of play and unresolved questions]. / Les incitations financières à la réalisation d'objectifs comportementaux liés à la santé - État des lieux et questions en suspens.

Programs providing monetary rewards to individuals who achieve a health-related goal (quitting smoking, losing weight, etc.) aim at promoting healthy behaviors. While these programs seem to achieve their objective in the short run, their ability to provoke lasting changes remains to be demonstrated. The identification of granting mechanisms likely to maximize the incentive effect of these rewards should be based on knowledge about individual attitudes evidenced by behavioral economics. As the latter has shown that preferences toward risk vary from one individual to another, these incentive mechanisms should be tailor-made according to individual preferences.

TITLE: Les incitations financières à la réalisation d'objectifs comportementaux liés à la santé - État des lieux et questions en suspens. ABSTRACT: Les programmes octroyant des récompenses pécuniaires aux individus qui parviennent à atteindre un objectif lié à la santé (arrêter de fumer, perdre du poids, etc.) ont pour but de favoriser l'adoption de comportements sains. Si ces dispositifs donnent des résultats encourageants à court terme, leur capacité à provoquer des changements de comportements durables reste à démontrer. L'identification des modalités d'octroi susceptibles de maximiser l'effet incitatif de ces récompenses devrait se fonder sur les connaissances relatives aux attitudes individuelles mises en évidence par l'économie comportementale. Cette dernière ayant montré que les préférences face à des situations de risque varient d'un individu à l'autre, ces mécanismes incitatifs devraient être conçus sur mesure en fonction des préférences individuelles.

Hospital's activity-based financing system and manager-physician [corrected] interaction.

This paper examines the consequences of the introduction of an activity-based reimbursement system on the behavior of physicians and hospital's managers. We consider a private for-profit sector where both hospitals and physicians are initially paid on a fee-for-service basis. We show that the benefit of the introduction of an activity-based system depends on the type of interaction between managers and physicians (simultaneous or sequential decision-making games). It is shown that, under the activity-based system, a sequential interaction with physician leader could be beneficial for both agents in the private sector. We further model an endogenous timing game à la Hamilton and Slutsky (Games Econ Behav 2: 29-46, 1990) in which the type of interaction is determined endogenously. We show that, under the activity-based system, the sequential interaction with physician leader is the unique subgame perfect equilibrium.

Aversion to health inequalities and priority setting in health care.

Traditionally aversion to health inequality is modelled through a concave utility function over health outcomes. Bleichrodt et al. [Bleichrodt, H., Diecidue E., Quiggin J., 2004. Equity weights in the allocation of health care: the rank-dependent QALY model. Journal of Health Economics 23, 157-171] have suggested a "dual" approach based on the introduction of explicit equity weights. The purpose of this paper is to analyze how priorities in health care are determined in the framework of these two models. It turns out that policy implications are highly sensitive to the choice of the model that will represent aversion to health inequality.

The optimality of hospital financing system: the role of physician-manager interactions.

The ability of a prospective payment system to ensure an optimal level of both quality and cost reducing activities in the hospital industry has been stressed by Ma (Ma, J Econ Manage Strategy 8(2):93-112, 1994) whose analysis assumes that decisions about quality and costs are made by a single agent. This paper examines whether this result holds when the main decisions made within the hospital are shared between physicians (quality of treatment) and hospital managers (cost reduction). Ma's conclusions appear to be relevant in the US context (where the hospital managers pay the whole cost of treatment). Nonetheless, when physicians partly reimburse hospitals for the treatment cost as it is the case in many European countries, we show that the ability of a prospective payment system to achieve both objectives is sensitive to the type of interaction (simultaneous, sequential or joint decision-making) between the agents. Our analysis suggests that regulation policies in the hospital sector should not be exclusively focused on the financing system but should also take the interaction between physicians and hospital managers into account.

Allocating health care resources under risk: risk aversion and prudence matter.

In a recent contribution to this journal, M. Hoel correctly shows that under risk aversion the allocation of health resources should be directed to health conditions for which the expected outcomes are below average. In this letter we show that besides risk aversion, the degree of absolute prudence (to be defined in the text) also matters to obtain an optimal allocation.

The effect of comorbidities on treatment decisions.

Medical decision analyses typically focus on one disease, that is, on one source of risk. In many medical decisions multiple sources of risk co-exist, however. This paper analyzes the effect of such comorbidities on treatment decisions. The effect of comorbidities on treatment decisions depends primarily on the way in which the patient's attitude to health status risks varies with duration. In the QALY model comorbidities do not affect treatment decisions. This property of the QALY model can be used as a diagnostic test of its descriptive and prescriptive validity.