A large fraction of total healthcare expenditure occurs due to end-of-life (EOL) care, which means it is important to study the problem of more carefully incentivizing necessary versus unnecessary EOL care because this has the potential to reduce overall healthcare spending. This paper introduces a principal-agent model that integrates a mixed payment system of fee-for-service and pay-for-performance in order to analyze whether it is possible to better align healthcare provider incentives with patient outcomes and cost-efficiency in EOL care. The primary contributions are to derive optimal contracts for EOL care payments using a principal-agent framework under three separate models for the healthcare provider, where each model considers a different level of risk tolerance for the provider. We derive these optimal contracts by converting the underlying principal-agent models from a bilevel optimization problem into a single-level optimization problem that can be analytically solved. Our results are demonstrated using a simulation where an optimal contract is used to price intracranial pressure monitoring for traumatic brain injuries.

翻译：医疗总支出中很大一部分来自临终关怀，因此研究如何更精细地激励必要与非必要的临终关怀至关重要，因为这有望降低整体医疗支出。本文引入了一个整合按服务收费与按绩效付费混合支付体系的委托-代理模型，以分析在临终关怀中能否更好地协调医疗服务提供方的激励与患者结局及成本效率之间的关系。主要贡献在于：基于委托-代理框架，针对医疗服务提供方的三种不同模型（每种模型考虑提供方的不同风险承受水平），推导出临终关怀支付的最优合同。我们通过将底层的委托-代理模型从双层优化问题转化为可解析求解的单层优化问题，推导出这些最优合同。研究结果通过模拟进行验证，该模拟将最优合同用于定价创伤性脑损伤患者的颅内压监测。