A game theoretic setting of capitation versus fee-for-service payment systems

Autoři: Allison Koenecke aff001
Působiště autorů: Institute for Computational & Mathematical Engineering, Stanford University, Stanford, California, United States of America aff001
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0223672


We aim to determine whether a game-theoretic model between an insurer and a healthcare practice yields a predictive equilibrium that incentivizes either player to deviate from a fee-for-service to capitation payment system. Using United States data from various primary care surveys, we find that non-extreme equilibria (i.e., shares of patients, or shares of patient visits, seen under a fee-for-service payment system) can be derived from a Stackelberg game if insurers award a non-linear bonus to practices based on performance. Overall, both insurers and practices can be incentivized to embrace capitation payments somewhat, but potentially at the expense of practice performance.

Klíčová slova:

Games – Health economics – Medical doctors – Nurses – Primary care – Quality of care – System stability – Game theory


1. Centers for Medicare & Medicaid Services. Comprehensive Primary Care Initiative [Internet]. 2016. Available: https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative

2. Basu S, Phillips RS, Song Z, Bitton A, Landon BE. High Levels Of Capitation Payments Needed To Shift Primary Care Toward Proactive Team And Nonvisit Care. Health Aff (Millwood). 2017;36: 1599–1605. doi: 10.1377/hlthaff.2017.0367 28874487

3. Ho K. Insurer-Provider Networks in the Medical Care Market. Am Econ Rev. 2009;99: 393–430. doi: 10.1257/aer.99.1.393 29504738

4. Ho K. The welfare effects of restricted hospital choice in the US medical care market. J Appl Econom. 2006;21: 1039–1079. doi: 10.1002/jae.896

5. Nishida K, Yoshida A. A comparison between two health care delivery systems using a spatial competition model approach. Reg Stud Reg Sci. 2016;3: 337–354. doi: 10.1080/21681376.2016.1209980

6. Bastani H, Bayati M, Braverman M, Johari R. Analysis of Medicare Pay-for-Performance Contracts. SSRN Electron J. 2016; doi: 10.2139/ssrn.2839143

7. Qing F, Luo L, Zhao M, Ren Q. Game Analysis and Improvement of the Medical Expenses Payment. In: Xu J, Cruz-Machado VA, Lev B, Nickel S, editors. Proceedings of the Eighth International Conference on Management Science and Engineering Management. Berlin, Heidelberg: Springer Berlin Heidelberg; 2014. pp. 35–43. doi: 10.1007/978-3-642-55182-6_4

8. Stearns SC, Wolfe BL, Kindig DA. Physician Responses to Fee-for-Service and Capitation Payment. Inquiry. 1992;29: 416–425. 1473865

9. Weiss AJ, Elixhauser A. Overview of Hospital Stays in the United States, 2012: Statistical Brief #180. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014. Available: http://www.ncbi.nlm.nih.gov/books/NBK259100/

10. Rosenthal MB, Alidina S, Friedberg MW, Singer SJ, Eastman D, Li Z, et al. Impact of the Cincinnati Aligning Forces for Quality Multi-Payer Patient Centered Medical Home Pilot on Health Care Quality, Utilization, and Costs. Med Care Res Rev MCRR. 2016;73: 532–545. doi: 10.1177/1077558715618566 26612180

11. Dahrouge S, Hogg W, Younger J, Muggah E, Russell G, Glazier RH. Primary Care Physician Panel Size and Quality of Care: A Population-Based Study in Ontario, Canada. Ann Fam Med. 2016;14: 26–33. doi: 10.1370/afm.1864 26755780

12. Angstman KB, Horn JL, Bernard ME, Kresin MM, Klavetter EW, Maxson J, et al. Family Medicine Panel Size with Care Teams: Impact on Quality. J Am Board Fam Med JABFM. 2016;29: 444–451. doi: 10.3122/jabfm.2016.04.150364 27390375

13. Luft HS, Miller RH. Patient Selection in a Competitive Health Care System. Health Aff (Millwood). 1988;7: 97–119. doi: 10.1377/hlthaff.7.3.97 3145918

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2019 Číslo 10
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