基于保险支付的内部工资激励对医生的行为的影响:实验证据
Xing Li1, Jiali Teng1, Xinyan Li1
1School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Fengtai District, Beijing, 100069, China.
BMC health services research
|December 15, 2023
概括
医生工资激励措施对服务提供和患者福利产生重大影响,特别是在浮动工资制度下. 了解这些反应是优化医疗保健支付方式和保险系统的关键.
科学领域:
- 卫生经济学 卫生经济学
- 医疗实践管理 医疗实践管理
- 行为经济学是一种行为经济学.
背景情况:
- 医生对付款方式的反应对于有效的医疗保健激励措施至关重要.
- 现有的理论缺乏关于不同支付结构下的医生行为的经验验证.
- 与诊断相关的群体 (DRG) 和服务费 (FFS) 支付模式影响医疗保健提供.
研究的目的:
- 实证地调查医生对内部工资激励措施的行为反应.
- 分析DRG和FFS支付方式对医生服务提供的影响.
- 评估不同工资结构如何影响患者福利.
主要方法:
- 一个实验室实验涉及150名医学学生扮演医生的角色.
- 参与者根据三个工资激励结构选择了医疗服务量:固定工资,固定与可变绩效,可变固定与可变绩效.
- 使用弗里德曼测试和固定效应模型分析的数据,与FFS或DRG余额相关的绩效工资.
主要成果:
- 固定工资并没有显著改变医生的行为,但最大限度地提高了患者的利益.
- 浮动工资制度表现出多种效应:增加的绩效工资在DRG下减少了服务,但在FFS下增加了服务,减少了患者福利.
- 工资组成的变化,总工资保持不变,对FFS产生了很小的影响,对DRG医生行为的影响微不足道.
结论:
- 内部工资激励措施可以将支付方式激励措施转移给医生,但需要仔细实施.
- 在使用支付方式余额来支付医生薪水时,建议谨慎使用,特别是在质量测量不完善的情况下.
- 优化医生补偿需要在不同的支付模式下平衡提供者激励与患者福利.
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