Kesteloot: martk versus overhei
Basisinzicht marktwerking.........................................................................................................................................6
maximale welvaart bij volmaakte mededinging...................................................................................................6
Basisinzicht........................................................................................................................................................6
Paretocriterium op markten.............................................................................................................................6
Markt van perfecte concurrente......................................................................................................................6
Voorwaarden voor perfecte concurrente....................................................................................................6
Ratonele economische agenten...............................................................................................................6
Consumenten en producenten zijn prijsnemers.......................................................................................6
Vrije toe- en uitreding tot de markt.........................................................................................................6
Transparante............................................................................................................................................6
Geen marktalingen...................................................................................................................................7
Markt evenwicht in perfecte concurrente p lange termijn.......................................................................7
Noot...................................................................................................................................................................7
Marktalingen............................................................................................................................................................7
Geen perfecte concurrente..................................................................................................................................7
Zorgverlening.....................................................................................................................................................7
Ziekteverzekering..............................................................................................................................................8
Publieke goederen.................................................................................................................................................8
kenmerken perfect zuivere goederen...............................................................................................................8
Niet-uitsluitbaarheid van consumpte...........................................................................................................8
Niet-rivaliteit in consumpte..........................................................................................................................8
Gevolgen i.g.v. vrije marktwerking: vrijbuitersprobleem.................................................................................8
Soorten publieke goederen...............................................................................................................................9
Externe efecten....................................................................................................................................................9
Soorten..............................................................................................................................................................9
Gevolgen i.g.v. vrije marktwerking....................................................................................................................9
Geen perfecte of volledige informate (onzekerheid)...........................................................................................9
principal (ongeïnformeerde partj)-agent(geïnformeerde partj) probleem....................................................9
complicates in de gezondheidszorg...........................................................................................................10
plossing p-a situates via contracten........................................................................................................10
Voorwaarden...........................................................................................................................................10
Toepassing in de gezondheidszorg..........................................................................................................10
nzekerheid over de impact van de actes op het resultaat..................................................................11
Informate problemen in Ziekteverzekering (pm)...........................................................................................11
1. Risico niet volledig contracteerbaar........................................................................................................11
, 2. Moral hazard ~ actes (hidden actons)...................................................................................................11
plossing:................................................................................................................................................11
3. averechtse selecte..................................................................................................................................11
plossingen: overheidsintervente.........................................................................................................................11
Doelstellingen......................................................................................................................................................11
Kanalen................................................................................................................................................................12
Voorbeelden....................................................................................................................................................12
Regulering van de prijs................................................................................................................................12
Belastngen en subsidies.............................................................................................................................12
Publieke zorgverlening/verzekering............................................................................................................12
Purchaser-provider split (VK, zweden)....................................................................................................12
GP-fundholding (VK)................................................................................................................................12
HM (health maintenance organisatons)..............................................................................................12
voorbeelden van overheidsintervente ssstemen..............................................................................................12
1. Bismarck model (sociaal zekerheidsmodel)................................................................................................12
2. Beveridge model (natonal health service).................................................................................................13
plossing voor publieke goederen, externe efecten en ongelijke verdeling....................................................13
Publieke goederen...........................................................................................................................................13
Vaccinate....................................................................................................................................................13
Maatregelen om epidemiën te vermijden..................................................................................................13
“opte” karakter van zorgverlening.............................................................................................................13
plossing: overheidsintervente.................................................................................................................14
externaliteiten.................................................................................................................................................14
Fssieke (positeve) externaliteiten..............................................................................................................14
Infecteziekten.........................................................................................................................................14
Psschologische (positeve) externaliteiten: altruïsme................................................................................14
Probleem van onvoldoende consumentensoevereiniteit...............................................................................14
Mogelijke oplossingen.................................................................................................................................14
Billijkheid in de gezondheidszorg....................................................................................................................15
Redenen......................................................................................................................................................15
Toepassing: gereguleerde concurrente..................................................................................................................15
Kenmerken..........................................................................................................................................................15
Voor en nadelen..................................................................................................................................................15
Gereguleerde concurrente in Nederland...........................................................................................................16
Recente stappen: 2006 wet ziekteverzekering..............................................................................................16
Verzekeraars....................................................................................................................................................16
Besluiten..........................................................................................................................................................16
, Toepassing in België/ mogelijkheden in België...................................................................................................16
Regulate zorgbekostging.......................................................................................................................................17
Algemeen.............................................................................................................................................................17
Financiering zorg vs privaat goed....................................................................................................................17
Kenmerken..........................................................................................................................................................17
1. Van retro naar prospectef.........................................................................................................................18
2. Van vast naar variabel.................................................................................................................................18
3. Van open-ended naar closed-end...............................................................................................................18
Globale kenmerken voorbeelden....................................................................................................................18
BFM.............................................................................................................................................................18
Honoraria.....................................................................................................................................................18
Impact op efciënte, kwaliteit, ….......................................................................................................................19
Retro- vs prospecteve nanciering................................................................................................................19
In praktjk.....................................................................................................................................................19
Impact prospecteve nanciering................................................................................................................19
Kostenbeheersing....................................................................................................................................19
kwaliteit..................................................................................................................................................20
patëntenselecte.....................................................................................................................................20
Gemengde nanciering...............................................................................................................................20
plossingen.................................................................................................................................................20
vast vs variabele nanciering..........................................................................................................................21
Macro nanciering..........................................................................................................................................21
Innovates: pas for performance.........................................................................................................................21
p4P (pas for performance), p4q......................................................................................................................22
Wat is P4P: performate..............................................................................................................................22
Knelpunten..............................................................................................................................................22
plossingen.............................................................................................................................................22
Absolute vs relateve performante.............................................................................................................22
plossing.................................................................................................................................................23
Gemengd sssteem...................................................................................................................................23
Wat is P4P: Pas............................................................................................................................................23
Beloning...................................................................................................................................................23
Extra middelen (new mones) of herverdeling ?.....................................................................................23
Wie wordt beloond: individu versus groep ?..........................................................................................24
Besluiten......................................................................................................................................................24
Basisinzicht marktwerking........................................................................................................................................3
maximale welvaart bij volmaakte mededinging...................................................................................................3
Basisinzicht marktwerking.........................................................................................................................................6
maximale welvaart bij volmaakte mededinging...................................................................................................6
Basisinzicht........................................................................................................................................................6
Paretocriterium op markten.............................................................................................................................6
Markt van perfecte concurrente......................................................................................................................6
Voorwaarden voor perfecte concurrente....................................................................................................6
Ratonele economische agenten...............................................................................................................6
Consumenten en producenten zijn prijsnemers.......................................................................................6
Vrije toe- en uitreding tot de markt.........................................................................................................6
Transparante............................................................................................................................................6
Geen marktalingen...................................................................................................................................7
Markt evenwicht in perfecte concurrente p lange termijn.......................................................................7
Noot...................................................................................................................................................................7
Marktalingen............................................................................................................................................................7
Geen perfecte concurrente..................................................................................................................................7
Zorgverlening.....................................................................................................................................................7
Ziekteverzekering..............................................................................................................................................8
Publieke goederen.................................................................................................................................................8
kenmerken perfect zuivere goederen...............................................................................................................8
Niet-uitsluitbaarheid van consumpte...........................................................................................................8
Niet-rivaliteit in consumpte..........................................................................................................................8
Gevolgen i.g.v. vrije marktwerking: vrijbuitersprobleem.................................................................................8
Soorten publieke goederen...............................................................................................................................9
Externe efecten....................................................................................................................................................9
Soorten..............................................................................................................................................................9
Gevolgen i.g.v. vrije marktwerking....................................................................................................................9
Geen perfecte of volledige informate (onzekerheid)...........................................................................................9
principal (ongeïnformeerde partj)-agent(geïnformeerde partj) probleem....................................................9
complicates in de gezondheidszorg...........................................................................................................10
plossing p-a situates via contracten........................................................................................................10
Voorwaarden...........................................................................................................................................10
Toepassing in de gezondheidszorg..........................................................................................................10
nzekerheid over de impact van de actes op het resultaat..................................................................11
Informate problemen in Ziekteverzekering (pm)...........................................................................................11
1. Risico niet volledig contracteerbaar........................................................................................................11
, 2. Moral hazard ~ actes (hidden actons)...................................................................................................11
plossing:................................................................................................................................................11
3. averechtse selecte..................................................................................................................................11
plossingen: overheidsintervente.........................................................................................................................11
Doelstellingen......................................................................................................................................................11
Kanalen................................................................................................................................................................12
Voorbeelden....................................................................................................................................................12
Regulering van de prijs................................................................................................................................12
Belastngen en subsidies.............................................................................................................................12
Publieke zorgverlening/verzekering............................................................................................................12
Purchaser-provider split (VK, zweden)....................................................................................................12
GP-fundholding (VK)................................................................................................................................12
HM (health maintenance organisatons)..............................................................................................12
voorbeelden van overheidsintervente ssstemen..............................................................................................12
1. Bismarck model (sociaal zekerheidsmodel)................................................................................................12
2. Beveridge model (natonal health service).................................................................................................13
plossing voor publieke goederen, externe efecten en ongelijke verdeling....................................................13
Publieke goederen...........................................................................................................................................13
Vaccinate....................................................................................................................................................13
Maatregelen om epidemiën te vermijden..................................................................................................13
“opte” karakter van zorgverlening.............................................................................................................13
plossing: overheidsintervente.................................................................................................................14
externaliteiten.................................................................................................................................................14
Fssieke (positeve) externaliteiten..............................................................................................................14
Infecteziekten.........................................................................................................................................14
Psschologische (positeve) externaliteiten: altruïsme................................................................................14
Probleem van onvoldoende consumentensoevereiniteit...............................................................................14
Mogelijke oplossingen.................................................................................................................................14
Billijkheid in de gezondheidszorg....................................................................................................................15
Redenen......................................................................................................................................................15
Toepassing: gereguleerde concurrente..................................................................................................................15
Kenmerken..........................................................................................................................................................15
Voor en nadelen..................................................................................................................................................15
Gereguleerde concurrente in Nederland...........................................................................................................16
Recente stappen: 2006 wet ziekteverzekering..............................................................................................16
Verzekeraars....................................................................................................................................................16
Besluiten..........................................................................................................................................................16
, Toepassing in België/ mogelijkheden in België...................................................................................................16
Regulate zorgbekostging.......................................................................................................................................17
Algemeen.............................................................................................................................................................17
Financiering zorg vs privaat goed....................................................................................................................17
Kenmerken..........................................................................................................................................................17
1. Van retro naar prospectef.........................................................................................................................18
2. Van vast naar variabel.................................................................................................................................18
3. Van open-ended naar closed-end...............................................................................................................18
Globale kenmerken voorbeelden....................................................................................................................18
BFM.............................................................................................................................................................18
Honoraria.....................................................................................................................................................18
Impact op efciënte, kwaliteit, ….......................................................................................................................19
Retro- vs prospecteve nanciering................................................................................................................19
In praktjk.....................................................................................................................................................19
Impact prospecteve nanciering................................................................................................................19
Kostenbeheersing....................................................................................................................................19
kwaliteit..................................................................................................................................................20
patëntenselecte.....................................................................................................................................20
Gemengde nanciering...............................................................................................................................20
plossingen.................................................................................................................................................20
vast vs variabele nanciering..........................................................................................................................21
Macro nanciering..........................................................................................................................................21
Innovates: pas for performance.........................................................................................................................21
p4P (pas for performance), p4q......................................................................................................................22
Wat is P4P: performate..............................................................................................................................22
Knelpunten..............................................................................................................................................22
plossingen.............................................................................................................................................22
Absolute vs relateve performante.............................................................................................................22
plossing.................................................................................................................................................23
Gemengd sssteem...................................................................................................................................23
Wat is P4P: Pas............................................................................................................................................23
Beloning...................................................................................................................................................23
Extra middelen (new mones) of herverdeling ?.....................................................................................23
Wie wordt beloond: individu versus groep ?..........................................................................................24
Besluiten......................................................................................................................................................24
Basisinzicht marktwerking........................................................................................................................................3
maximale welvaart bij volmaakte mededinging...................................................................................................3
