| Essay One: Genetic Health Risks: The Case for Universal Public Health Insurance. This paper examines the appropriate role for the public sector in providing genetic and health insurance when health risks are genetically determined at conception. The ex ante efficient outcome (when individuals are ignorant about their health risks) is characterized. It is demonstrated that this outcome cannot be achieved by private health insurance markets or by a government which cannot commit to a once-and-for-all transfer policy. In contrast, the desired outcome is attained through public provision of universal health insurance and of genetic testing, coupled with a public pension scheme.;Essay Three: Comparative Efficiency Assessment of Primary Care Models Using Data Envelopment Analysis. This paper compares the productive efficiency of four models of primary care service delivery in Ontario, Canada, using the methodology of Data Envelopment Analysis. Particular care is taken to include quality of service in the output measure. The influence of the delivery model on productive efficiency is disentangled from patient characteristics using regression analysis. The traditional fee-for-service arrangement ranks highest and the Community Health Centre model (which involves a multidisciplinary team of health care professionals paid on a salary basis) the lowest in efficiency scoring. The reliance of input measures on the costs of running a practice and on the number of patients favours the fee-for-service model.;Essay Two: Fee-for-Service vs. Capitation: Anything You Can Do - I Can Do Better (and Cheaper). This paper recasts the analysis of optimal physician remuneration - generally presented as a contest between prospective (capitation) and retrospective (fee-for-service) schemes - as a problem in price theory. This approach abstracts from problems of asymmetric information and concentrates on the design of the price mechanism. It demonstrates that when the demand for health care is price-inelastic, the appropriately designed fee-for-service and capitation schemes both lead to Pareto efficient outcomes. When a patient's demand for care is uncertain, or the risk of poor health outcomes depends on the preventive care provision, standard arguments concerning risk bearing are used to prove that paying physicians on a fee-for-service basis can deliver socially-optimal outcomes at a lower cost than if they are paid under a capitation scheme. |
