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Working Paper No. 209. Resolving the Coordination Problem in Health Care

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Företagandets villkor, Mattias Lundbäck, Sjukvård
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Abstract

The underlying reason for the lack of coordination of health care production is often attributed to the lack of central cost accountability for each individual patient. The rather few health care producers that manages to coordinate health care all the way from primary care to tertiary care are often used as good examples, e g Veterans administration, Kaiser Permanente, Intermountain Health Care and The Mayo Clinics. However, due to large cost variability amongst patients (economic risk), information asymmetries and agency problems, the provision of health care is rarely coordinated. More commonly, the delivery of health care production is reimbursed in a non-coordinated way that creates incentives for sub-optimisation and holds back entrepreneurship among producers. In this paper we use data from the Medical Expenditure Panel Survey and computer simulations to illustrate that limiting a provider’s cost responsibility for each patient is a much more efficient way of reducing provider risk than to increase the number of patients. Our simulations illustrate that introducing an individual yearly cost ceiling of 20 000 US-dollars per patient reduces risk as much as increasing the number of patients from 5 000 to 100 000. The results indicate that it might be possible to create a favourable environment for coordination in managed care organisations, such as those mentioned above, without exposing providers to extensive risk. Reimbursements systems of the type used in Medicare Advantage might thus be slightly adjusted to reduce the barriers of entry (economic risk) and promote the entry of integrated care providers on the market.

Lundbäck, M. (2013). Resolving the Coordination Problem in Health Care: Limited Responsibility HMO:s. Ratio Working Paper No. 209.

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Ratio Working Paper No. 349: Industrial conflict in essential services in a new era – Swedish rules in a comparative perspective
Working paperPublication
Karlson, N.
Publication year

2021

Published in

Ratio Working Paper

Abstract

This paper examines whether the Swedish regulatory system of dealing with industrial conflicts that affect essential services need an update or reform. Are the existing rules effective in a world where many essential services are upheld by many interdependent agents in complex systems where every single node becomes critical for the functioning of the system, and where the essential service activities could be either private or public? A comparative study is conducted with the corresponding regulatory systems of the United Kingdom, Germany, and Denmark.
The conclusion is that Sweden is a special case. The Swedish protection against and readiness in dealing with societally harmful industrial conflicts in essential services is weaker than in the countries of comparison. Just as in relation to other threats to essential services, it is not sustainable to claim that just because such a threat is not currently present, there would be no need for preparedness.
There are many alternative ways to handle this. Desirable methods should both prevent harmful conflicts from erupting and end conflicts that have grown harmful to society at a later stage. The labour market organisations should have a mutual interest in reforming the rules.

Ratio Working Paper No. 349: Industrial conflict in essential services in a new era – Swedish rules in a comparative perspective
Working paperPublication
Karlson, N.
Publication year

2021

Published in

Ratio Working Paper

Abstract

This paper examines whether the Swedish regulatory system of dealing with industrial conflicts that affect essential services need an update or reform. Are the existing rules effective in a world where many essential services are upheld by many interdependent agents in complex systems where every single node becomes critical for the functioning of the system, and where the essential service activities could be either private or public? A comparative study is conducted with the corresponding regulatory systems of the United Kingdom, Germany, and Denmark.
The conclusion is that Sweden is a special case. The Swedish protection against and readiness in dealing with societally harmful industrial conflicts in essential services is weaker than in the countries of comparison. Just as in relation to other threats to essential services, it is not sustainable to claim that just because such a threat is not currently present, there would be no need for preparedness.
There are many alternative ways to handle this. Desirable methods should both prevent harmful conflicts from erupting and end conflicts that have grown harmful to society at a later stage. The labour market organisations should have a mutual interest in reforming the rules.

Ratio Working Paper No. 348: Regional collaboration to enhance recruitment to rural regions
Working paperPublication
Nyström, K.
Publication year

2021

Published in

Ratio Working Paper

Abstract

The purpose of this paper is to study how municipalities work at the regional level with issues concerning skills shortages and recruitment. What information channels are used to obtain information about these shortcomings? How and with whom do the municipalities collaborate? This study provides a mapping of how collaboration between employers, regional policymakers, and other institutions works with regional recruitment. As such, this study provides important information and possible inspiration. The empirical findings obtained based on a survey targeted to the business sections in Swedish municipalities suggest that companies in rural regions turn to municipalities to a greater extent than companies in non-rural municipalities in regard to skills shortages and recruitment. In addition, it is perceived that there is a higher degree of cooperation between businesses and local politicians in regard to recruitment in rural municipalities compared to other municipalities. Even cooperation to develop competence at the regional level is thought to take place to a greater extent in rural municipalities than in non-rural municipalities.

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