医药分离制度对医疗市场效率的影响:来自实验的证据  

The Effect of Separation of Prescription and Treatment on the Efficiency of Health Care Market:Evidence from Experiment

作　　者：陈叶烽[1,2] 罗干松 刘莹 Chen Yefeng;Luo Gansong;Liu Ying(College of Economics,Zhejiang University,Hangzhou 310058)

机构地区：[1]浙江大学经济学院,杭州310058 [2]浙江大学跨学科社会科学研究中心

出　　处：《浙江社会科学》2021年第8期11-22,156,共13页Zhejiang Social Sciences

基　　金：国家自然科学基金面上项目“信息不对称背景下经验品和信任品市场的信任机制实验研究”(批准号:71773111);浙江省哲学社会科学规划重点项目“医改背景下医生薪酬激励机制的对比实验研究”(批准号:18NDJC027Z);中央高校基本科研业务费专项资金的资助。

摘　　要：医药分离是解决我国医疗市场上“看病贵”、“看病难”等现实问题的重要医改举措,本文首先研究医药分离制度对医疗市场效率的影响,并在此基础上进一步探究引入竞争因素能否扩大医药分离制度对市场效率的正面影响。实验结果表明,医药分离制度对市场效率的提高作用有限,主要原因在于较高的价格使得病人接受诊断服务的意愿下降,由此导致的效率损失部分抵消了过度治疗率下降带来的效率增加。竞争机制的引入对医生的过度治疗行为有明显的抑制作用,但对医疗市场效率的影响存在差异:仅医生或药店一方的竞争会在减少过度治疗的同时带来新的市场效率损失,而当医生和药店双方均竞争时,市场效率损失最小,病人福利也得到显著提升,因为此时病人更愿意进入市场接受诊断,医生的过度治疗行为也明显减少。本文的研究对进一步推动我国医药分离制度改革、解决医疗市场的问题具有重要的现实意义。Separation of prescription and treatment is an important medical reform measure to solve the practical problems of“inadequate and overly expensive medical service”in China’s medical market.In this paper,we study the effect of the separation of prescription and treatment system on the efficiency of medical market,and further explore whether the introduction of competition can expand the positive impact of medical separation system on market efficiency.We observe that the effect of the medical separation system on the improvement of market efficiency is limited,mainly because higher prices make patients less willing to enter the market and accept diagnostic services,and the resulting efficiency loss partially offsets the efficiency increase caused by the decline in overtreatment.In addition,the introduction of competition can significantly reduce overtreatment,but the impact on the efficiency of the medical market varies:competition from doctors or pharmacies alone can lead to new market efficiency loss while reducing overtreatment;but when both doctors and pharmacies compete,the loss of market efficiency is minimal,and the patients’welfare is significantly improved,because patients are more willing to enter the market for diagnosis,and the doctors’overtreatment is significantly reduced.Our research has important practical significance to further promote the reform of China’s separation of prescription and treatment system and solving the problems in the medical market.

关 键 词：信任品 医药分离 市场竞争 过度治疗 市场效率 

分 类 号：R197.1[医药卫生—卫生事业管理]