Strategic costs and preferences revelation in the allocation of resources for health care



This article examines the resources allocation process in the internal market for health care in an environment characterised by asymmetry of information. We analyse the strategic behaviour of the provider and show how, by misreporting its cost function and reservation utility, it might shift the allocation of resources away from the purchaser’s objectives. Although the fundamental importance of equity, efficiency and risk aversion considerations which have been the traditional focus of the literature on allocation of resources should not be denied, this paper shows that contracts and internal markets are not neutral instruments and more research should be devoted to studying their effects.


Internal market Asymmetry of information Intrinsic motivation 

JEL Classification

I11 I18 


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  1. Baron D. P., Myerson R. B. (1982) Regulating a monopolist with unknown costs. Econometrica 50(4): 911–930CrossRefGoogle Scholar
  2. Chalkley M., Malcomson J. H. (2002) Cost sharing in health service provision: An empirical assessment of cost saving. Journal of Health Economics 84: 219–249Google Scholar
  3. Delfgaauw J., Dur R. (2007) Signalling and screening of workers’ motivation. Journal of Economic Behavior and Organization 62(4): 605–624CrossRefGoogle Scholar
  4. Delfgaauw J., Dur R. (2008) Incentives and workers’ motivation in the public sector. Economic Journal 118(525): 171–191Google Scholar
  5. Francois P. (2000) Public service motivation as an argument for government provision. Journal of Public Economics 78: 275–299CrossRefGoogle Scholar
  6. Glazer A. (2004) Motivating devoted workers. International Journal of Industrial Economics 22: 427–440Google Scholar
  7. Gouveia M. (1997) Majority rule and the public provision of a private good. Public Choice 1: 1–24Google Scholar
  8. Gravelle H. (1999) Capitation contracts: Access and quality. Journal of Health Economics 18(3): 315–340CrossRefGoogle Scholar
  9. Hoel M. (2003) Allocating health care resources when people are risk averse with respect to life time. Health Economics 12(7): 601–608CrossRefGoogle Scholar
  10. Jack W. (2005) Purchasing health care services from providers with unknown altruism. Journal of Health Economics 24(1): 73–93CrossRefGoogle Scholar
  11. Kreps D. M. (1997) Intrinsic motivation and extrinsic incentives. The American Economic Review 87(2): 359–364Google Scholar
  12. Laffont J. J., Tirole J. (1993) A theory of incentives in procurement and regulation. The MIT Press, Cambridge, MAGoogle Scholar
  13. Levaggi R. (2005) Hospital health care: Cost reimbursement and quality control in a spatial model with asymmetry of information. International Journal of Health Care Finance and Economics 5(4): 327–349CrossRefGoogle Scholar
  14. Levaggi R. (2007) Internal markets for hospital care: Cost and quality control in a spatial competition model. Journal of Regulatory Economics 32(2): 173–193CrossRefGoogle Scholar
  15. Levaggi, L., & Levaggi, R. (2009). Regulation strategies for public service provision. Available at SSRN:
  16. Levaggi, L., & Levaggi, R. (2010). Welfare properties of restrictions to health care based on cost effectiveness. Health Economics.
  17. Levaggi R., Moretto M. (2008) Investment in hospital care technology under different purchasing rules: A real option approach. Bulletin of Economic Research 60(2): 159–173CrossRefGoogle Scholar
  18. Macinko J., Starfield B. (2002) Annotated bibiliography on equity in health. International Journal on Equity in Health I: 1–20CrossRefGoogle Scholar
  19. McGuire, T. (2000). Physician agency (Vol. 1, Chap. 9, pp. 461–536.). Elsevier Science.Google Scholar
  20. Phuong B., Crainich D., Eeckhoudt L. (2005) Allocating health care resources under risk: Risk aversion and prudence matter. Health Economics 14(10): 1073–1077CrossRefGoogle Scholar
  21. Scott, A. (2000). The Economics of general practice (Vol. 1B, Chap. 22, pp. 1175–1200). Amsterdam: Elsevier Science.Google Scholar
  22. Terry L. M. (2004) An integrated approach to resource allocation. Health-Care Analysis 17(2): 171–180CrossRefGoogle Scholar
  23. Wagstaff A. (1991) QALYs and the equity-efficiency trade off. Journal of Health Economics 10: 21–41CrossRefGoogle Scholar
  24. Williams A., Kind P. (1992) The present state of play about QUALYs. In: Hopkins A. (eds) Measures of the quality of life. Royal College of Physicians, London, pp 21–34Google Scholar
  25. Zweifel, P. (2004). Multiple payers in health care: A framework for assessment. HNP Discussion Paper, World Bank, New York.

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Faculty of Science and Technology, Free University of BozenBolzanoItaly
  2. 2.Dipartimento di Scienze EconomicheUniversità di BresciaBresciaItaly

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