Free riding and participation in large scale, multi-hospital kidney exchange

[Clark]

http://onlinelibrary.wiley.com/store/10.3982/TE1357/asset/THEC138.pdf?v=1&t=i1c2wryf&s=4a877e2a08d33a60c352ad0c1c13dace7cd7221e

Free riding and participation in large scale, multi-hospital kidney exchange
Itai Ashlagi, Alvin E. Roth, Theoretical Economics 9 (2014), 817–863 1555-7561/20140817

Abstract

"As multi-hospital kidney exchange has grown, the set of players has grown from patients and surgeons to include hospitals. Hospitals can choose to enroll only their hard-to-match patient–donor pairs, while conducting easily arranged exchanges internally. This behavior has already been observed.

We show that as the population of hospitals and patients grows, the cost of making it individually rational for hospitals to participate fully becomes low in almost every large exchange pool (although the worst-case cost is very high), while the cost of failing to guarantee individual rationality is high—in lost transplants. We identify a mechanism that gives hospitals incentives to reveal all patient–donor pairs. We observe that if such a mechanism were to be implemented and hospitals enrolled all their pairs, the resulting patient pools would allow efficient matchings that could be implemented with two- and three-way exchanges."

[donor99]

Isn't it sad that Medicaid only patients cant be in pared exchanges outside of their own state unless the donor can travel. Medicaid only will not pay for shipped kidneys to their in state recipients...Boo State Medicaid....so silly...you pay for deceased donor kidneys from other states. Wake up.