Creaming, skimping and dumping: provider competition on the intensive and extensive margins
分析不同报销方式下，医疗服务提供者如何对轻症患者过度服务（撇脂）、对重症患者服务不足（偷工减料）或直接拒绝重症患者（甩客），并比较社会最优与私人均衡的差异。
Reimbursement incentives influence both the intensity of services and who is treated when patients differ in severity of illness. The social optimum is compared to the private Cournot-Nash solution for three provider strategies: creaming--over-provision of services to low severity patients; skimping--under-provision of services to high severity patients; and dumping--the explicit avoidance of high severity patients. Cost-based reimbursement results in overprovision of services (creaming) to all types of patients. Prospectively paid providers cream low severity patients and skimp high severity ones. If there is dumping of high severity patients, then there will also be skimping.