---
_id: '44092'
abstract:
- lang: eng
  text: "We study how competition between physicians affects the provision of medical
    care. In\r\nour theoretical model, physicians are faced with a heterogeneous patient
    population, in which patients\r\nsystematically vary with regard to both their
    responsiveness to the provided quality of care and their\r\nstate of health. We
    test the behavioral predictions derived from this model in a controlled laboratory\r\nexperiment.
    In line with the model, we observe that competition significantly improves patient
    benefits\r\nas long as patients are able to respond to the quality provided. For
    those patients, who are not able\r\nto choose a physician, competition even decreases
    the patient benefit compared to a situation without\r\ncompetition. This decrease
    is in contrast to our theoretical prediction implying no change in benefits for\r\npassive
    patients. Deviations from patient-optimal treatment are highest for passive patients
    in need of\r\na low quantity of medical services. With repetition, both, the positive
    effects of competition for active\r\npatients as well as the negative effects
    of competition for passive patients become more pronounced. Our\r\nresults imply
    that competition can not only improve but also worsen patient outcome and that
    patients’\r\nresponsiveness to quality is decisive."
article_type: original
author:
- first_name: Jeannette
  full_name: Brosig-Koch, Jeannette
  last_name: Brosig-Koch
- first_name: Burkhard
  full_name: Hehenkamp, Burkhard
  id: '37339'
  last_name: Hehenkamp
- first_name: Johanna
  full_name: Kokot, Johanna
  last_name: Kokot
citation:
  ama: Brosig-Koch J, Hehenkamp B, Kokot J. Who benefits from quality competition
    in health care? A theory and a laboratory experiment on the relevance of patient
    characteristics. <i>Health Economics</i>. Published online 2023. doi:<a href="https://doi.org/10.1002/hec.4689">10.1002/hec.4689</a>
  apa: Brosig-Koch, J., Hehenkamp, B., &#38; Kokot, J. (2023). Who benefits from quality
    competition in health care? A theory and a laboratory experiment on the relevance
    of patient characteristics. <i>Health Economics</i>. <a href="https://doi.org/10.1002/hec.4689">https://doi.org/10.1002/hec.4689</a>
  bibtex: '@article{Brosig-Koch_Hehenkamp_Kokot_2023, title={Who benefits from quality
    competition in health care? A theory and a laboratory experiment on the relevance
    of patient characteristics}, DOI={<a href="https://doi.org/10.1002/hec.4689">10.1002/hec.4689</a>},
    journal={Health Economics}, author={Brosig-Koch, Jeannette and Hehenkamp, Burkhard
    and Kokot, Johanna}, year={2023} }'
  chicago: Brosig-Koch, Jeannette, Burkhard Hehenkamp, and Johanna Kokot. “Who Benefits
    from Quality Competition in Health Care? A Theory and a Laboratory Experiment
    on the Relevance of Patient Characteristics.” <i>Health Economics</i>, 2023. <a
    href="https://doi.org/10.1002/hec.4689">https://doi.org/10.1002/hec.4689</a>.
  ieee: 'J. Brosig-Koch, B. Hehenkamp, and J. Kokot, “Who benefits from quality competition
    in health care? A theory and a laboratory experiment on the relevance of patient
    characteristics,” <i>Health Economics</i>, 2023, doi: <a href="https://doi.org/10.1002/hec.4689">10.1002/hec.4689</a>.'
  mla: Brosig-Koch, Jeannette, et al. “Who Benefits from Quality Competition in Health
    Care? A Theory and a Laboratory Experiment on the Relevance of Patient Characteristics.”
    <i>Health Economics</i>, 2023, doi:<a href="https://doi.org/10.1002/hec.4689">10.1002/hec.4689</a>.
  short: J. Brosig-Koch, B. Hehenkamp, J. Kokot, Health Economics (2023).
date_created: 2023-04-20T17:02:41Z
date_updated: 2023-04-20T17:16:14Z
department:
- _id: '280'
- _id: '475'
doi: 10.1002/hec.4689
jel:
- I11
- D43
- C91
keyword:
- physician competition
- patient characteristics
- heterogeneity in quality responses
- fee-for-service
- laboratory experiment
language:
- iso: eng
project:
- _id: '1'
  name: 'SFB 901: SFB 901'
- _id: '2'
  name: 'SFB 901 - A: SFB 901 - Project Area A'
- _id: '7'
  name: 'SFB 901 - A3: SFB 901 - Subproject A3'
publication: Health Economics
quality_controlled: '1'
status: public
title: Who benefits from quality competition in health care? A theory and a laboratory
  experiment on the relevance of patient characteristics
type: journal_article
user_id: '37339'
year: '2023'
...
---
_id: '31847'
abstract:
- lang: eng
  text: "The famous $k$-Server Problem covers plenty of resource allocation scenarios,
    and several variations have been studied extensively for decades. However, to
    the best of our knowledge, no research has considered the problem if the servers
    are not identical and requests can express which specific servers should serve
    them. Therefore, we present a new model generalizing the $k$-Server Problem by
    *preferences* of the requests and proceed to study it in a uniform metric space
    for deterministic online algorithms (the special case of paging).\r\n\r\nIn our
    model, requests can either demand to be answered by any server (*general requests*)
    or by a specific one (*specific requests*). If only general requests appear, the
    instance is one of the original $k$-Server Problem, and a lower bound for the
    competitive ratio of $k$ applies. If only specific requests appear, a solution
    with a competitive ratio of $1$ becomes trivial since there is no freedom regarding
    the servers' movements. Perhaps counter-intuitively, we show that if both kinds
    of requests appear, the lower bound raises to $2k-1$.\r\n\r\nWe study deterministic
    online algorithms in uniform metrics and present two algorithms. The first one
    has an adaptive competitive ratio dependent on the frequency of specific requests.
    It achieves a worst-case competitive ratio of $3k-2$ while it is optimal when
    only general or only specific requests appear (competitive ratio of $k$ and $1$,
    respectively). The second has a fixed close-to-optimal worst-case competitive
    ratio of $2k+14$. For the first algorithm, we show a lower bound of $3k-2$, while
    the second algorithm has a lower bound of $2k-1$ when only general requests appear.\r\n
    \   \r\nThe two algorithms differ in only one behavioral rule for each server
    that significantly influences the competitive ratio. Each server acting according
    to the rule allows approaching the worst-case lower bound, while it implies an
    increased lower bound for $k$-Server instances. In other words, there is a trade-off
    between performing well against instances of the $k$-Server Problem and instances
    containing specific requests. We also show that no deterministic online algorithm
    can be optimal for both kinds of instances simultaneously."
author:
- first_name: Jannik
  full_name: Castenow, Jannik
  id: '38705'
  last_name: Castenow
- first_name: Björn
  full_name: Feldkord, Björn
  id: '22704'
  last_name: Feldkord
- first_name: Till
  full_name: Knollmann, Till
  id: '39241'
  last_name: Knollmann
  orcid: 0000-0003-2014-4696
- first_name: Manuel
  full_name: Malatyali, Manuel
  id: '41265'
  last_name: Malatyali
- first_name: Friedhelm
  full_name: Meyer auf der Heide, Friedhelm
  id: '15523'
  last_name: Meyer auf der Heide
citation:
  ama: 'Castenow J, Feldkord B, Knollmann T, Malatyali M, Meyer auf der Heide F. The
    k-Server with Preferences Problem. In: <i>Proceedings of the 34th ACM Symposium
    on Parallelism in Algorithms and Architectures</i>. Association for Computing
    Machinery; 2022:345-356. doi:<a href="https://doi.org/10.1145/3490148.3538595">10.1145/3490148.3538595</a>'
  apa: Castenow, J., Feldkord, B., Knollmann, T., Malatyali, M., &#38; Meyer auf der
    Heide, F. (2022). The k-Server with Preferences Problem. <i>Proceedings of the
    34th ACM Symposium on Parallelism in Algorithms and Architectures</i>, 345–356.
    <a href="https://doi.org/10.1145/3490148.3538595">https://doi.org/10.1145/3490148.3538595</a>
  bibtex: '@inproceedings{Castenow_Feldkord_Knollmann_Malatyali_Meyer auf der Heide_2022,
    title={The k-Server with Preferences Problem}, DOI={<a href="https://doi.org/10.1145/3490148.3538595">10.1145/3490148.3538595</a>},
    booktitle={Proceedings of the 34th ACM Symposium on Parallelism in Algorithms
    and Architectures}, publisher={Association for Computing Machinery}, author={Castenow,
    Jannik and Feldkord, Björn and Knollmann, Till and Malatyali, Manuel and Meyer
    auf der Heide, Friedhelm}, year={2022}, pages={345–356} }'
  chicago: Castenow, Jannik, Björn Feldkord, Till Knollmann, Manuel Malatyali, and
    Friedhelm Meyer auf der Heide. “The K-Server with Preferences Problem.” In <i>Proceedings
    of the 34th ACM Symposium on Parallelism in Algorithms and Architectures</i>,
    345–56. Association for Computing Machinery, 2022. <a href="https://doi.org/10.1145/3490148.3538595">https://doi.org/10.1145/3490148.3538595</a>.
  ieee: 'J. Castenow, B. Feldkord, T. Knollmann, M. Malatyali, and F. Meyer auf der
    Heide, “The k-Server with Preferences Problem,” in <i>Proceedings of the 34th
    ACM Symposium on Parallelism in Algorithms and Architectures</i>, 2022, pp. 345–356,
    doi: <a href="https://doi.org/10.1145/3490148.3538595">10.1145/3490148.3538595</a>.'
  mla: Castenow, Jannik, et al. “The K-Server with Preferences Problem.” <i>Proceedings
    of the 34th ACM Symposium on Parallelism in Algorithms and Architectures</i>,
    Association for Computing Machinery, 2022, pp. 345–56, doi:<a href="https://doi.org/10.1145/3490148.3538595">10.1145/3490148.3538595</a>.
  short: 'J. Castenow, B. Feldkord, T. Knollmann, M. Malatyali, F. Meyer auf der Heide,
    in: Proceedings of the 34th ACM Symposium on Parallelism in Algorithms and Architectures,
    Association for Computing Machinery, 2022, pp. 345–356.'
date_created: 2022-06-10T09:06:42Z
date_updated: 2022-08-02T08:07:30Z
department:
- _id: '63'
doi: 10.1145/3490148.3538595
external_id:
  arxiv:
  - '2205.11102'
keyword:
- K-Server Problem
- Heterogeneity
- Online Caching
language:
- iso: eng
page: 345-356
project:
- _id: '1'
  name: 'SFB 901: SFB 901'
- _id: '2'
  name: 'SFB 901 - A: SFB 901 - Project Area A'
- _id: '5'
  name: 'SFB 901 - A1: SFB 901 - Subproject A1'
publication: Proceedings of the 34th ACM Symposium on Parallelism in Algorithms and
  Architectures
publication_identifier:
  isbn:
  - '9781450391467'
publisher: Association for Computing Machinery
status: public
title: The k-Server with Preferences Problem
type: conference
user_id: '39241'
year: '2022'
...