基于实验经济学方法的不同支付方式对医生决策行为影响研究  

Impact of Different Payment Methods on Physician D ecision-Making Behavior Based on an Experimental Economics Approach

作　　者：吴雨涵 吾麦尔艾力·阿力木 侯艳英 卢若艳[1] Wu Yuhan;Wumai’eraili Alimu;Hou Yanying;Lu Ruoyan(School of Health Management,Fujian Medical University,Fuzhou,Fujian,350108,China;不详)

机构地区：[1]福建医科大学卫生管理学院,福建福州350108 [2]福建医科大学公共卫生学院,福建福州350108

出　　处：《中国医院管理》2024年第5期22-26,共5页Chinese Hospital Management

基　　金：福建省社会科学基金项目(FJ2022B075);福建省科协科技创新智库课题研究项目(FJKX-2022XKB011)。

摘　　要：目的探索医生在不同医保支付方式下及面对不同健康状况患者时提供医疗服务行为的变化。方法招募110名医学院校学生作为被试者,通过实验经济学方法模拟医生进行医疗行为决策场景。结果被试者在按服务项目支付(fee-for-service,FFS)中为每名患者提供的医疗服务平均数量高于按人头支付(capitation payment,CAP);被试者在混合支付方式下提供的服务数情况优于单一支付方式;FFS系统中对重症患者的最优决策比例最高,而在CAP系统中对轻症和重症患者作出的最优决策数差异无统计学意义(P>0.05);不同支付方式、医生利润及患者健康状况对被试者提供的最优决策存在影响。结论在FFS系统中,轻症患者接受了更多的过度医疗服务;在CAP系统中,中症和重症患者治疗不足的情况更严重;混合支付方式能够一定程度克服单一支付方式的弊端,发挥综合优势。被试者在提供医疗行为的过程中存在利他异质性,可以通过改变外部客观条件和优化内生性因素对医生决策行为进行干预。Objective Exploring changes in physicians'healthcare delivery behaviors across medicare payment methods and when dealing with patients with different health statuses.Methods One hundred and ten medical students were recruited as subjects to simulate physicians making medical,behavioral decision scenarios through an experimental economics approach.Results The average number of medical services provided by subjects per patient was higher in fee-for-service(FFS)than in capitation payment(CAP);the situation of the number of services provided by subjects was better in mixed payment than in a single payment.The proportion of optimal decisions made by subjects for critically ill patients was the highest in the FFS system,whereas the difference in the number of optimal decisions made by subjects for mildly ill and critically ill patients in the CAP system was not statistically significant(P>0.05);different payment methods,physician profits,and patient health status had an effect on the optimal decisions made by subjects.Conclusion In the FFS system,mildly ill patients are more over-treated,while moderately severe patients are more under-treated in the CAP system;hybrid payments can partly overcome the drawbacks of a single payment method and take advantage of a combination of advantages.There is altruistic heterogeneity in the behavior of subjects in the provision of health care,and interventions in physicians'decisionmaking behavior can be carried out by altering the external objective conditions and optimizing the endogenous factors.

关 键 词：实验经济学 医生决策行为 按人头支付 按服务项目支付 利他性 

分 类 号：R197.1[医药卫生—卫生事业管理]