Buso M., B. Cesi, Coretti, S. and Turati, G., (2024) Contracting Unverifiable Quality in Healthcare: The Importance of Political Stability for Relational Contracts, SSRN

We consider an infinitely repeated game between a public purchaser of a health service and a semi-altruistic hospital when some quality dimensions of the service are non-contractible. We discuss how a Pay-for-Performance Relational Contract (P4PRC) can induce the hospital to deliver positive unverifiable quality. We find that the optimal conditions for both price and quantities of the P4P-RC converge to the first-best the higher the stability of the interaction between the purchaser and the hospital. Using the length of tenure of regional politicians in Italy as a proxy for a stable interaction, we empirically test the relationship between proxies of healthcare service quality and political stability from 1996 to 2020. We find evidence supporting the view that unverifiable quality increases in the political stability of the regional governments.