通讯作者: 韩优莉, hanyouli@ccmu.edu.com

DOI：10.12201/bmr.202211.00015

The Effect of Introducing Competition Mechanism in the Contracted Family Doctor Services on Physicians’ Behaviors: Experimental study

• 摘要：目的：基于家庭医生签约背景，检验支付方式结合竞争“双机制”对医生行为的影响，为家庭医生签约制度的完善提供实验经济学证据。方法：通过受控实验室实验，设计非竞争和竞争场景，结合按人头付费（CAP）和按项目付费（FFS）支付方式，开展实验经济学研究。招募162名医学生作为受试者，为不同疾病严重程度的患者选择提供的医疗服务数量。利用随机效应模型分析竞争机制对医疗服务数量和患者健康效益的影响；通过费舍尔组合检验，探讨不同支付方式引入竞争机制对医生行为影响的差异。结果：竞争机制引入后会减少CAP（FFS）支付方式下服务量供给不足（供给过度）的程度。对于健康状况差（好）的患者，竞争机制在CAP（FFS）支付方式下对医生行为改变程度更大。竞争机制组间系数比较显示，相比于FFS, “CAP+竞争机制”患者健康效益损失更少。相比于不竞争转为竞争场景，在竞争转为不竞争场景下医生提供服务量与患者健康效益最优服务量的偏移程度增加。结论：引入竞争机制可以改善家庭医生医疗服务质量，按人头付费结合竞争的双机制设计具有一定的优势。

  关键词： 竞争机制; 家庭医生签约; 医疗服务行为; 实验室实验

   

  Abstract: Objectives: To investigate the effects of the “dual mechanism” of payment systems and competition on doctors’ behavior under the background of family doctor contract, and to provide experimental economics evidence for the improvement of the family doctor contract system. Methods: A controlled laboratory experiment was conducted in the design of non-competitive and competitive scenarios combining with two payment systems, capitation (CAP) and fee-for-service (FFS). We recruited 162 medical students as subjects to provide the medical treatment for the patients with different severities. The random effects model was used to analyze the effect of competition mechanisms on the doctors’ medical treatment and patients’ health benefit; Fisher’s combination test was used to explore the differences in the impact of introducing competition mechanism to different payment systems on doctors’ behavior. Results: Introducing competition mechanism can reduce under-provision under CAP and overprovision under FFS respectively. For patients in poor (good) health condition, the competition mechanism changed doctors’ behavior more apparently under CAP (FFS). The comparison of the intergroup coefficients for the competition mechanism showed that, compared with “FFS + competition”, the loss of patients’ health benefit was less under “CAP + competition” mechanism. Compared with no-competition to competition scenario, the deviation from patient optimal treatment increased in the competition to no-competition scenario. Conclusion: The treatment quality of family doctors is improved by introducing competition mechanism, the dual mechanism design of CAP combined with competition is more advantageous.

  Key words: competition mechanism; family doctor contract; physicians’ behaviour; laboratory experiment

  提交时间：2022-11-23

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
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• 序号	提交日期	编号	操作
  1	2022-09-07	bmr.202211.00015V1	下载

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