Associate Professor of Public Policy
Market Structure, Commitment, and Treatment Incentives in Health Care.
Miller, Nolan. "Market Structure, Commitment, and Treatment Incentives in Health Care." KSG Faculty Research Working Paper Series RWP04-007, February 2004.
People are more distrustful of managed care organizations (MCOs) than traditional health plans, a phenomenon that has become known as "managed-care backlash." In a model of the relationship between a patient, insurer, and physician, this paper shows that when the roles of insurer and provider are combined into a single player (as in a staff-model HMO), the equilibrium insurance plan departs from the social optimum, due to the fact that the HMO cannot credibly commit to providing non-least-cost care. In contrast, when the insurer and provider roles are separate, as in fee-for-service insurance, the equilibrium reimbursements for the physician implement the first-best treatment regime at first-best cost. Thus, the relative inability of MCOs to commit to non-least-cost care may account for at least part of managed-care backlash.