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The B.E. Journal of Economic Analysis & Policy

Editor-in-Chief: Jürges, Hendrik / Ludwig, Sandra

Ed. by Auriol, Emmanuelle / Brunner, Johann / Fleck, Robert / Mastrobuoni, Giovanni / Mendola, Mariapia / Requate, Till / de Vries, Frans / Zulehner, Christine

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Volume 18, Issue 1


Volume 6 (2006)

Volume 4 (2004)

Volume 2 (2002)

Volume 1 (2001)

Public Health Insurance with Monopolistically Competitive Providers and Optional Spot Sales

Gilad Sorek / T. Randolph Beard
Published Online: 2018-01-23 | DOI: https://doi.org/10.1515/bejeap-2016-0309


We study the implications of extending public-insurance coverage over differentiated medical products of the same therapeutic group to market outcomes. The public insurer can set the reimbursement level for medical providers and the copayment for the insured for medical care provided under the policy coverage, but cannot directly control providers’ spot sales (outside of insurance) price. In this setup, the price offered by the public insurer to medical providers must maintain their reservation profit from selling on the spot market directly to consumers. We show that the public insurer can manipulate this reservation profit by setting the copayment rate, and thereby promote market welfare while increasing consumers’ surplus due to lower medical prices and lower market entry. The results survive generalizations including moral hazard and incomplete insurance coverage.

Keywords: public-insurance; spatial competition; spot sales; market efficiency

JEL Classification: I-13; I-18; K-35


  • Bardey, D., C. Cantac, and J.-M. Lozachmeur. 2012. “The Regulation of Health Care Providers’ Payments when Horizontal and Vertical Differentiation Matters”. Journal of Health Economics 31:691–704.CrossrefGoogle Scholar

  • Bardey, D., H. Cremer, and J-M Lozachmeur. 2016a. “The Design of Insurance Coverage for Medical Products under Imperfect Competition”. Journal of Public Economics 137:28–37.Web of ScienceCrossrefGoogle Scholar

  • Bardey, D., B. Jullien, and J-M. Lozachmeur. 2016b. “Health Insurance and Diversity of Treatment: A Policy Mix Perspective”. Journal of Health Economics 47:50–63.CrossrefGoogle Scholar

  • Brekke, K., C. Canta, and O.R. Straume 2016. “Reference Pricing with Endogenous Generic Entry”. Journal of Health Economics 50:312–329.CrossrefWeb of ScienceGoogle Scholar

  • Carone, G., C. Schwierz, and A. Xavier. 2012. “Cost-containment Policies in Public Pharmaceutical Spending in the EU”. European Economy, Economic Papers 461, European Commission. http://apps.who.int/medicinedocs/documents/s19981en/s19981en.pdf.

  • DiMasi, J. A., and C. Paquette. 2004. “The Economics of Follow-on Drug Research and Development: Trends in the Entry Rates and the Timing of Development”. Pharmaco Economics 22:1–14.CrossrefGoogle Scholar

  • Douven, R, R. Halbersma, K. Katona, and V. Shestalova. 2014. “Vertical Integration and Exclusive Behavior of Insurers and Hospitals”. Journal of Economics & Management Strategy 23:344–368.Web of ScienceCrossrefGoogle Scholar

  • Duggan M., and F. Scott-Morton. 2010. “The Effect of Medicare Part D on Pharmaceutical Prices and Utilization”. American Economic Review 100:590–607.Web of ScienceCrossrefGoogle Scholar

  • Duggan M., and F. Scott Morton. 2011. “The Medium-term Impact of Medicare Part D on Pharmaceutical Prices”. American Economic Review 101:387–392.CrossrefWeb of ScienceGoogle Scholar

  • Economides, N. 1993. “Quality Variations in the Circular Model of Variety Differentiated Products”. Regional Science and Urban Economics 23:235–257.CrossrefGoogle Scholar

  • Ehrlich, I., and G. S. Becker. 1972. “Market Insurance, Self-Insurance and Self Protection”. Journal of Political Economy 80:623–649.CrossrefGoogle Scholar

  • Gal–Or, E. 1999. “Mergers and Exclusionary Practices in Health Care Markets”. Journal of Economics & Management Strategy 8:315–350.CrossrefGoogle Scholar

  • Gaynor, M., and R. J. Town. 2012. “Competition in Healthcare Markets”. In Handbook of Health Economics, Volume 2, Chapter 9, edited by T. G. McGuire, M. V. Pauly and P. Pita Barros. Amsterdam and London: Elsevier North-Holland.Google Scholar

  • Grossman, V. 2013. “Do Cost-sharing and Entry Deregulation Curb Pharmaceutical Innovation?” Journal of Health Economics 32:881–894.CrossrefWeb of ScienceGoogle Scholar

  • Lakdawalla, D., and N. Sood. 2009. “Innovation and the Welfare Effects of Public Drug Insurance”. Journal of Public Economics 93:541–548.CrossrefWeb of ScienceGoogle Scholar

  • Lakdawalla, D., and N. Sood. 2013. “Health Insurance as a Two-part Pricing Contract”. Journal of Public Economics 102:1–12.CrossrefWeb of ScienceGoogle Scholar

  • Mankiw N. G., and M. D. Whinston. 1986. “Free Entry and Social Inefficiency”. RAND Journal of Economics 17:48–58.CrossrefGoogle Scholar

  • Nell, M., A. Richter, and J. Schiller. 2009. “When Prices Hardly Matter: Incomplete Insurance Contracts and Markets for Repair Goods”. European Economic Review 53:343–354.CrossrefWeb of ScienceGoogle Scholar

  • Ridley, D. B. 2015. “Payments, Promotion, and the Purple Pill”. Health Economics 24:86–103.CrossrefWeb of ScienceGoogle Scholar

  • Salop, S. C. 1979. “Monopolistic Competition with Outside Goods”. The Bell Journal of Economics 10:141–156.CrossrefGoogle Scholar

  • Sood, N., H. de Vries, I. Gutierrez, D. N. Lakdawalla, and D. P. Goldman. 2009. “The Effect of Pharmaceutical Regulation on Revenues”. Health Affairs 28: 125–137.Web of ScienceCrossrefGoogle Scholar

  • Vaithianathan, R. 2006. “Health Insurance and Imperfect Competition in the Healthcare Market”. Journal of Health Economics 25:1193–1202.CrossrefGoogle Scholar

About the article

Published Online: 2018-01-23

Citation Information: The B.E. Journal of Economic Analysis & Policy, Volume 18, Issue 1, 20160309, ISSN (Online) 1935-1682, DOI: https://doi.org/10.1515/bejeap-2016-0309.

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