Working paper

Health Care Network Formation and Policyholders' Welfare

David Bardey, and Jean-Marc Bourgeon


We develop a model in which two insurers and two health care providers compete for a fixed mass of policyholders. Insurers compete in premium and offer coverage against financial consequences of health risk. They have the possibility to sign agreements with providers to establish a health care network. Providers, partially altruistic, are horizontally differentiated with respect to their physical address. They choose the health care quality and compete in price. First, we show that policyholders are better off under a competition between conventional insurance rather than under a competition between integrated insurers (Managed Care Organizations). Second, we reveal that the competition between a conventional insurer and a Managed Care Organization (MCO) leads to a similar equilibrium than the competition between two MCOs characterized by a different objective i.e. private versus mutual. Third, we point out that the ex ante providers' horizontal differentiation leads to an exclusionary equilibrium in which both insurers select one distinct provider. This result is in sharp contrast with frameworks that introduce the concept of option value to model the (ex post) horizontal differentiation between providers.


Health care network; horizontal differentiation; health care quality;

JEL codes

  • I11: Analysis of Health Care Markets
  • L11: Production, Pricing, and Market Structure • Size Distribution of Firms
  • L14: Transactional Relationships • Contracts and Reputation • Networks
  • L42: Vertical Restraints • Resale Price Maintenance • Quantity Discounts


David Bardey, and Jean-Marc Bourgeon, Health Care Network Formation and Policyholders' Welfare, TSE Working Paper, n. 10-183, August 11, 2010.

See also

Published in

TSE Working Paper, n. 10-183, August 11, 2010