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Strategic sorting: the role of ordeals in health care

Published online by Cambridge University Press:  15 June 2020

Richard Zeckhauser Open the ORCID record for Richard Zeckhauser [Opens in a new window]
Richard Zeckhauser*
Affiliation:
Harvard Kennedy School, 79 John F. Kennedy St., Cambridge, MA02138, USA
*
Email: [email protected]
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Abstract

Ordeals are burdens placed on individuals that yield no benefits to others; hence they represent a dead-weight loss. Ordeals – the most common is waiting time – play a prominent role in rationing health care. The recipients most willing to bear them are those receiving the greatest benefit from scarce health-care resources. Health care is heavily subsidized; hence, moral hazard leads to excess use. Ordeals are intended to discourage expenditures yielding little benefit while simultaneously avoiding the undesired consequences of rationing methods such as quotas or pricing. This analysis diagnoses the economic underpinnings of ordeals. Subsidies for nursing-home care versus home care illustrate.

Keywords

ordealtarget efficiencysignallingmoral hazardsortinghealth care
Type
Symposium Article
Information
Economics & Philosophy , Volume 37 , Special Issue 1: Special Issue on Ethics of Economic Ordeals , March 2021 , pp. 64 - 81
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Canadian Institute for Health Information n.d. National Health Expenditure Trends, 1975 to 2018. <https://www.cihi.ca/sites/default/files/document/nhex-trends-narrative-report-2018-en-web.pdf>..>Google Scholar
Carter, O., Pannekoek, L., Fursland, A., Allen, K.L., Lampard, A.M. and Byrne, S.M. 2012. Increased wait-list time predicts dropout from outpatient enhanced cognitive behaviour therapy (CBT-E) for eating disorders. Behaviour Research and Therapy 50, 487–492.CrossRefGoogle ScholarPubMed
Centers for Medicare & Medicaid Service 2018. National Health Expenditure Data. <https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nationalhealthaccountshistorical.html>, accessed 11 December 2018.,+accessed+11+December+2018.>Google Scholar
Centers for Medicare and Medicaid Service 2019. Medicare Prescription Drug Appeals and Grievances: Exceptions. <https://www.cms.gov/Medicare/Appeals-and-Grievances/MedPrescriptDrugApplGriev/Exceptions.html>, accessed 5 March 2019.,+accessed+5+March+2019.>Google Scholar
Chambers, J.D., Cangelosi, M.J. and Neumann, P.J.. 2015. Medicare’s use of cost-effectiveness analysis for prevention (but not for treatment). Health Policy 119, 156–163.CrossRefGoogle Scholar
Coste, J., Delecoeuillerie, G., de Lara Cohen, A., Le Parc, J.M. and Paolaggi, J.B. 1994. Clinical course and prognostic factors in acute low back pain: an inception cohort study in primary care practice. British Medical Journal 308, 577–580.CrossRefGoogle ScholarPubMed
Dupas, P., Hoffmann, V., Kremer, M. and Zwane, A.P. 2016. Targeting health subsidies through a nonprice mechanism: a randomized controlled trial in Kenya. Science 353, 889–895.CrossRefGoogle ScholarPubMed
Eastwood, D. 2011. Experience of adults with low back pain awaiting consultation with a spinal surgeon. 62–63. Library and Archives Canada (Bibliothèque et Archives Canada). <https://bac-lac.on.worldcat.org/oclc/813520756>..>Google Scholar
Elflein, J. 2019. Patient wait times for U.S. dental appointments in 2018, by dentist type. <https://www.statista.com/statistics/964787/patient-wait-times-for-dental-appointments-by-speciality/>..>Google Scholar
Fraser Institute 2018. Waiting your Turn: Wait Times for Health Care in Canada, 2018 Report. <http://bit.ly/2rgVT6B>..>Google Scholar
Genworth 2019. Cost of Long Term Care. 2018 Cost of Care Report. <https://www.genworth.com/aging-and-you/finances/cost-of-care.html>, accessed 28 March 2019.,+accessed+28+March+2019.>Google Scholar
Goldstein, D.A. 2016. Using quality-adjusted life-years in cost-effectiveness analyses: do not throw out the baby or the bathwater. Journal of Oncology Practice 12, 500–502.CrossRefGoogle ScholarPubMed
Kahneman, D. and Tversky, A. 1979. Prospect theory: an analysis of decision under risk. Econometrica 47, 263–291.CrossRefGoogle Scholar
Lieber, E.M.J. and Lockwood, L.M. 2019. Targeting with in-kind transfers: evidence from Medicaid home care. American Economic Review 109, 1461–1485.CrossRefGoogle ScholarPubMed
Mani, A., Mullainathan, S., Shafir, E. and Zhao, J. 2013. Poverty impedes cognitive function. Science 341, 976–980.CrossRefGoogle ScholarPubMed
Medicare 2019. What Drug Plans Cover. <https://www.medicare.gov/drug-coverage-part-d/what-drug-plans-cover>, accessed 29 April 2019.,+accessed+29+April+2019.>Google Scholar
Nichols, A.L. and Zeckhauser, R.J. 1982. Targeting transfers through restrictions on recipients. American Economic Review 72, 372–77.Google Scholar
Office for National Statistics 2016. UK Health Accounts – Office for National Statistics. <https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/bulletins/ukhealthaccounts/2016>, accessed 22 April 2019.,+accessed+22+April+2019.>Google Scholar
Papanicolas, I., Woskie, L.R. and Jha, A.K. 2018. Health care spending in the United States and other high-income countries. Journal of the American Medical Association 319, 1024–1039.CrossRefGoogle ScholarPubMed
Pratt, J.W., Wise, D.A. and Zeckhauser, R. 1979. Price differences in almost competitive markets. Quarterly Journal of Economics 93, 189–211.CrossRefGoogle Scholar
Saez, E., Slemrod, J. and Giertz, S.H.. 2012. The elasticity of taxable income with respect to marginal tax rates: a critical review. Journal of Economic Literature 50, 3–50.CrossRefGoogle Scholar
Selby, J.V., Fireman, B.H. and Swain, B.E. 1996. Effect of a copayment on use of the emergency department in a health maintenance organization. New England Journal of Medicine 334, 635–642.CrossRefGoogle Scholar
Spence, M. 1973. Job market signaling. Quarterly Journal of Economics 87, 355–374.CrossRefGoogle Scholar
Willson, P.D. 2012. Remembering Katie Beckett. Pediatric Nursing 38, 227.Google Scholar
Zeckhauser, R. and Shepard, D.. 1976. Where now for saving lives? Law and Contemporary Problems 40(4), 5–45.CrossRefGoogle Scholar