医疗服务模式改革与信用就医:一项田野实验研究  

Healthcare Service Model Reform and Credit-based Care:A Field Experiment Study

作　　者：吴记 郭咏琳 林浩添[3] 吴小龙[4,5] 张熙钰 Wu Ji;Guo Yonglin;Lin Haotian;Wu Xiaolong;Zhang Xiyu(School of Business,Sun Yat-sen University;School of Government,Sun Yat-sen University;State Key Laboratory of Ophthalmology;.Zhongshan Ophthalmic Center,Sun Yat-sen University;Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science;Business School,Sun Yat-sen University;Research Center for Innovation,Entrepreneurship,and Technology Finance,Sun Yat-sen University)

机构地区：[1]中山大学管理学院 [2]中山大学政治与公共事务管理学院 [3]中山大学中山眼科中心、眼科学国家重点实验室、广东省眼科视觉科学重点实验室 [4]中山大学商学院 [5]中山大学·深圳创新创业与科技金融研究中心

出　　处：《管理世界》2025年第2期114-127,共14页Journal of Management World

基　　金：国家自然科学基金优秀青年科学基金项目“大数据驱动用户管理”(72322020);国家自然科学基金青年项目“人与AI协同的场景‘学习—知识—决策’机制研究”(72202244);国家自然科学基金面上项目“数据驱动的消费者在线违规行为鉴别与治理”(72071218);国家自然科学基金重大研究计划重点支持项目“基于数字孪生的内源性干细胞原位再生晶状体时空演化规律研究”(92368205)的资助。

摘　　要：看病难,其成因之一为“窗口排队”和“频繁支付”的诊疗流程繁复。为践行“以患者为中心”的服务理念,改善就医体验,公立医疗机构开始推行“先诊疗后结算”的服务模式改革。然而,利民政策面临现实挑战,带来患者诊疗费用未及时缴纳及医院管理成本增加的风险。本文基于国内某三甲专科医院推行“先诊疗后结算”服务模式改革的现实场景开展田野实验,从框架效应和解释水平理论出发,系统探索信息设计对患者支付医疗欠费的助推效应。实验结果表明:(1)相较于基准提醒信息,个人框架和社会框架信息均有效促进患者支付医疗欠费,个人框架信息效果更为显著;(2)个人框架下,损失信息比收益信息更能促进患者支付医疗欠费;(3)社会框架下,收益信息比损失信息更能促进患者支付医疗欠费。本文研究发现信息助推设计能够有效促进患者信用就医,是低成本高收益的干预方式。本文将信息助推纳入患者医疗欠费研究情境,拓展框架效应研究边界,研究结论为我国推行“先诊疗后结算”服务模式改革提供实践指导,为提高医疗服务效率带来启示,对实现以人民健康为中心的医疗服务改革有重要的借鉴意义。Difficulty in receiving qualified healthcare service is partly attributed to the complex diagnostic and treatment processes involving"queue at windows"and"frequent payments".To optimize the healthcare service model and improve the care service process,and to implement the service concept of"patient-centered",China has implemented the health service reform of"diagnosis and treatment first,settlement later"in public hospitals.However,pro-people policies face real challenges,bringing risks of delayed payment of patients'medical fees and increased hospital management costs.Based on the real scenario of patients'unpaid medical fees in the reform of the"diagnosis and treatment first,settlement later"service model implemented in a domestic tertiary specialist hospital,this study designs a field experiment to explore methods of information design to facilitate patients'payment of medical debts based on the framing effect and the construal level theory.The experiment results indicate that compared to the baseline reminder information,both individual frames and social frames significantly enhance patients'payment of medical debts,and compared with social frames,the effect of individual frames is more manifest.Furthermore,under the individual frame,information emphasizing losses is more effective in promoting patients'payment of medical debts compared to information emphasizing gains.Under the social frame,information emphasizing gain is more effective in promoting patients'payment of medical debts compared to information emphasizing losses.Our study indicates that information design interventions can effectively promote patients'credit-based medical behaviors,recover hospital losses,and belong to low-cost,high-reward intervention methods.This study incorporates information design into the research context of patients'medical debts,expands the boundaries of framing effects research,and provides practical guidance for the implementation of"diagnosis and treatment first,settlement later"service model in China.It also offers i

关 键 词：信息助推 信用就医 医疗欠费支付 田野实验 框架效应 

分 类 号：R197.1[医药卫生—卫生事业管理]