Game theory and mechanism design for cooperative competition dilemmas between healthcare providers

Permanent URL: http://hdl.handle.net/2047/D20211212
Title:
Game theory and mechanism design for cooperative competition dilemmas between healthcare providers
Creator:
Bettinger, Brendan Michael (Author)
Contributor:
Benneyan, James C. (Advisor)
Berkowitz, Randi (Committee member)
Ergai, Awatef (Committee member)
Language:
English
Publisher:
Boston, Massachusetts : Northeastern University, 2016
Date Accepted:
May 2016
Date Awarded:
August 2016
Type of resource:
Text
Genre:
Dissertations
Format:
electronic
Digital origin:
born digital
Abstract/Description:
Cooperation among healthcare providers should be encouraged to achieve the public health benefits of efficient coordination, yet natural competition in healthcare markets often creates incentive to choose strategies that favor the individual provider. This conflict can interfere with the ideal of coordinated care when less efficient solutions add to rising healthcare costs. National health spending reached $2.8 trillion in 2012 and is expected to exceed 20% of the United States gross domestic product by 2022, while an estimated one third of healthcare spending is waste including $190 billion due to overtreatment and $160 billion due to failures of care delivery and care coordination.

This dissertation extends the application of game theory models in healthcare to characterize the effects of such market failures and proposes mechanism design solutions to discourage overtreatment and promote care coordination for three example applications. The developed underlying mathematical models create a general framework to help providers, payors, and policymakers understand healthcare market dynamics, while the example applications ground this research with actionable recommendations to improve quality and reduce costs in real world scenarios.

Chapter 2 develops a commons dilemma model to characterize antibiotic prescribing behavior and proposes three alternate approaches (collective cooperative management, use taxes, and resistance penalties) to promote appropriate use in stewardship efforts. Chapter 3 develops a volunteer's dilemma model to characterize the potential for care coordination failures in accountable care organizations, proposes three economic mechanisms that can help ensure patients receive indicated care, and explores possible outcomes of a mixed strategy equilibrium for a time-dynamic extension. Chapter 4 presents a fair division application to design effective incentives between a payor and a contracted healthcare provider (here a skilled nursing facility), developing a chance constrained programming model to identify the optimal split of shared savings to incentivize improved quality and an assignment algorithm to determine the maximum payment for higher performing facilities that accept more patients. Finally, Chapter 5 discusses the practical implications of this work, potential limitations of these models, and possible extensions.
Subjects and keywords:
healthcare
mechanism design
Game theory
Health services administration -- United States
Medical economics -- United States
Medical policy -- Economic aspects -- United States
Medical care -- Economic aspects -- United States
Contracting out -- United States
Cooperativeness -- United States
DOI:
https://doi.org/10.17760/D20211212
Permanent Link:
http://hdl.handle.net/2047/D20211212
Use and reproduction:
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