二次诊疗能否有效抑制过度医疗?——基于社会偏好异质性的实验研究  

Do Second Opinions Effectively Inhibit Overtreatment?—An Experiment Based on Heterogeneous Social Preferences

作　　者：陈叶烽[1,2] 黄娟 陈夏静 Chen Yefeng;Huang Juan;Chen Xiajing

机构地区：[1]浙江大学经济学院,浙江省杭州市310058 [2]浙江大学跨学科社会科学研究中心 [3]网易(杭州)网络有限公司

出　　处：《南方经济》2024年第11期1-17,共17页South China Journal of Economics

基　　金：国家自然科学基金面上项目“过度医疗的治理机制和实验检验:基于医生支付激励的视角”(72173116);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”(71773111);浙江省哲学社会科学规划重点项目“DRGs医保支付方式潜在道德风险的机制设计和实验检验”(22NDJC004Z);中央高校基本科研业务费专项资金资助。

摘　　要：医疗市场是一个典型的信任品市场,存在着普遍的过度医疗现象。二次诊疗作为市场竞争的一种形式,从缓解信息不对称的角度提供了一个重要的治理思路。文章基于社会偏好异质性的视角,利用实验室实验方法模拟医疗情境,检验了二次诊疗机制对于抑制过度医疗行为的有效性及稳健性。实验结果表明,首先,社会偏好存在异质性,且不同社会偏好的被试在行为决策上存在明显差异。其中亲社会偏好和强自利偏好被试的比例分别为54.17%和33.33%,且前者的过度医疗率均低于后者;其次,二次诊疗机制总体上可以显著降低过度医疗率,然而当医生可以识别患者的问诊次数时,过度医疗率会大幅上升甚至高于无二次诊疗机制的基准情况;最后,二次诊疗机制的效果依赖于被试的社会偏好类型,该机制对亲社会偏好被试的约束作用大于其他偏好被试。文章的研究结论对我国医疗市场制度改革具有重要的政策参考价值,随着互联网医疗和人工智能技术的兴起,完善和推广二次诊疗机制可以作为治理过度医疗现象的重要措施。此外,医疗体制改革还需要考虑政策在不同群体中的稳健性问题,强化医生的职业道德建设。As a typical credence goods market,the medical market suffers from inefficiencies caused by superior information of physicians.Overtreatment is the most common form of physicians'fraudulence,which not only increases the cost of patients,but also results in waste on medical resources.Based on the heterogeneity of social preferences,we apply a laboratory experiment to study the effectiveness and robustness of second opinions on inhibiting overtreatment.In the recognition of social preferences,54.17%of the subjects are efficiency-loving,and 33.33%of the subjects are highly self-interested.The overtreatment rate of efficiency-loving physicians is lower than that of self-interested physicians.In the analysis of the effectiveness of the mechanism,we confirm that second opinions do significantly inhibit overtreatment.However,if physicians can identify patients requesting second opinions,the overall overtreatment rate will dramatically rise,even higher than that in the condition without second opinions.For the sub-sample divided by social preferences,the effect of second opinions is not robust:self-interested physicians'behavior doesn't perform significantly different,while efficiency-loving physicians'overtreatment rate decreases significantly.This study provides important policy references for Chinese medical system reform.With the emergence of online healthcare and artificial intelligence technology,promoting second opinions can serve as a significant approach to mitigate overtreatment.Moreover,the government needs to address the resilience of policies across diverse demographics,such as reinforcing physicians'professional ethics.

关 键 词：医疗市场 二次诊疗 社会偏好 过度医疗 

分 类 号：F069[经济管理—政治经济学]