Universal health systems often rely on both pubic provision and contracting arrangements with private hospitals. This paper studies the optimal mix of public and private provision of health care services. We propose a model in which the regulator acts as athird‐party payer, and aims to ensure universal access to treatment at minimal cost. Patients need one unit of medical services and differ in the severity of illness. A private and a public hospital are available. Under incomplete contracts, ownership affects the regulatory constraints and the power of managerial incentives. Only the private manager internalizes profits, and has incentives to reject costly patients and to exert effort in cost reduction. Contracting with the private hospital is optimal when managerial effort is relatively effective in reducing costs. By using the public hospital as a last resort provider, the regulator can ensure access, provide incentives to the private manager, and internalize part of the resulting cost savings. Imposing a no‐dumping constraint on the private hospital reduces the power of incentives and is not always optimal.

中文翻译：

---

效率，获取和混合提供医疗保健服务

全民保健系统通常既依赖于公共服务，又依赖与私立医院的合同安排。本文研究了公共和私人提供医疗保健服务的最佳组合。我们提出了一种模型，在该模型中，监管机构充当第三方付款人，旨在确保以最小的成本获得普遍的治疗。患者需要一种单位的医疗服务，并且病情轻重不一。提供私立医院和公立医院。在不完整的合同下，所有权会影响监管限制和管理激励措施的力量。只有私人经理才能使利润内部化，并有动机拒绝昂贵的患者并努力降低成本。当管理工作在降低成本方面相对有效时，与私立医院签约是最佳选择。通过将公立医院用作最后的提供者，监管机构可以确保使用公立医院，向私人经理提供激励措施以及将由此产生的部分成本节约内部化。对私家医院施加无倾销约束会降低激励的力量，而且并非总是最优的。