走一个额外的英里? 一般医生对家庭检查的费用进行升级编码
Jamie O'Halloran1, Anne Sophie Oxholm1, Line Bjørnskov Pedersen1,2
1Department of Public Health, Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark.
Health economics
|November 3, 2023
概括
丹麦的全科医生 (GPs) 被研究了家庭访问旅行费的潜在"游戏". 分析显示,尽管有收入激励措施,一般医生操纵费用没有因果关系证据.
科学领域:
- 卫生经济学 卫生经济学
- 主要护理医学 医疗保健
- 医疗保健政策 医疗保健政策
背景情况:
- 一般医生的收入往往与自我报告的数据有关,这为系统的财务"游戏"创造了潜力.
- 一般医生的家庭访问涉及旅行,相关费用为报酬操纵提供了机会.
研究的目的:
- 调查丹麦的全科医生是否参与家庭访问旅行费的游戏.
- 为了确定费用结构的变化是否会激励旅行距离的升级编码.
主要方法:
- 综合行政和地理数据,以比较GP家庭访问的行程与收费距离.
- 利用自然实验利用家庭访问费的上升来评估游戏行为.
- 采用具有GP固定效应的线性概率模型来分析费用变化对计费实践的影响.
主要成果:
- 在具有灵活计费选项的访问中,上编码 (比行程长的距离计费) 发生的频率略高于下编码 (16%对13%).
- 家庭访问费用上与上代码的小幅减少有关 (0.6%的访问).
- 在不同的距离带中,尽管收费增加不同,但在上编码减少方面没有观察到统计学上显著的差异.
结论:
- 这项研究没有发现任何因果关系证据表明丹麦的全科医生在家庭访问时会花费旅行费.
- 基于激励的费用结构并没有导致全科医生增加升级编码行为.
- 调查结果表明,目前的系统可能不容易受到一般医生在家庭访问中广泛使用的费用游戏的影响.
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