激励与压力:医疗市场机制影响医生群体的两种路径  

Incentives and Pressures:Two Paths for the Medical Market Mechanism in Influencing Doctor Groups

作　　者：许弘智 XU Hongzhi(School of Marxism,Xiamen University,Xiamen,Fujian,China)

机构地区：[1]厦门大学马克思主义学院

出　　处：《政治经济学季刊》2024年第3期134-162,共29页Political Economy Quarterly

基　　金：福建省社会科学规划项目(重大项目)“中国式现代化的本质要求研究”(项目编号:FJ2023Z002)的资助。

摘　　要：自中国改革开放以来,市场机制逐渐被引入公共医疗服务领域之中。而作为医疗服务的直接供给者,医生群体究竟是否因此受到激励,从而感到市场化能带来收入的增加与地位的提升?本研究基于一项针对医生的全国调查数据对此展开考察。与以往单一强调市场机制的激励效应等研究不同,本研究认为,医疗委托—代理过程中的市场机制对医生群体的影响同时存在激励与压力这两种路径。一方面,激励效应和压力传递在结构上具有不对称性,即两种路径作用于不同特征的医生,形成了群体上的分异。另一方面,压力传递路径具有来自医院组织的内部压力和来自患者的外部压力这两重维度,且内部—外部压力变量对医生地位的提升存在负向交互效应。此外,压力传递路径还具有层级积累效果,即相较于三甲医院,内部—外部压力变量更为显著地削减了非三甲医院医生对收入与地位水平提升的感受。研究结果揭示了医疗市场机制条件下医生群体的复杂工作状况和社会心态,为部分医生对市场化的不满提供了一个基于压力传递路径的解释。The market mechanism has been gradually introduced into the field of public medical services since the reform and opening up.However,do the direct providers of medical services feel motivated by this and approve that marketization has brought about an increase in their income and social⁃status level?Apart from previous research that simply emphasize the incentive effect of market mechanism,the current research based on a national survey of Chinese doctors and finds that there are both incentive and pressure paths for the influence of the market mechanism on doctors in the medical principal⁃agent process.On the one hand,the incentive effect path and the pressure transmission path are asymmetric in structure,where two paths act on doctors with different characteristics and forms differentiation in the doctor groups.On the other hand,the pressure transmission path has two dimensions:internal pressure from hospital organizations and external pressure from patients.Both internal and external pressure variables have a negative interaction effect on the promotion of doctors'status.In addition,the pressure transmission path also has an accumulation effect.Compared with Grade⁃A tertiary hospitals,the internal external pressure variable significantly reduces the income and status level of doctors in the other hospitals.The research results reveal the complex working conditions and social mentality of doctors under the background of the medical marketization reform,and provide an explanation based on pressure transmission path for some doctors'dissatisfaction towards marketization.

关 键 词：医疗市场化 医生群体 激励—压力结构 压力传递 潜类分析 

分 类 号：F27[经济管理—企业管理]