Optimal compensation rule under provider adverse selection and moral hazard.

Although healthcare provider payments have been studied extensively in the literature, little is known about the optimal compensation rule when, in addition to unobservable provider effort (moral hazard), the provider's ability type is also private information (adverse selection). We find that when only provider effort is unobservable, to induce the first-best outcome the optimal compensation rule requires zero fee-for-service. When both provider moral hazard and adverse selection exist, the first-best outcome will be infeasible. The second-best compensation rule entails combined use of capitation, fee-for-service, and pay-for-performance.