一般医生的薪酬制度是否会影响他们的抗生素处方行为?
Yana V Zykova1,2, Eivor H Hoff3,4,5, Kristian B Kraft3,6
1Cluster for Health Service Research, Norwegian Institute of Public Health, Oslo, Norway. yana.zykova@fhi.no.
Health economics review
|February 6, 2026
概括
一般医生的支付模式影响了对呼吸道感染的抗生素处方. 服务费/人均模式与更高的处方率和更广泛的抗生素使用有关,这凸显了政策调整的需要.
科学领域:
- 卫生经济学 卫生经济学
- 公共卫生 公共卫生
- 一般的做法一般的做法
背景情况:
- 抗生素耐药性是全球主要的健康问题.
- 在初级保健中,过度处方用于呼吸道感染 (RTIs) 的抗生素对这种威胁有很大影响.
- 一般医生 (GPs) 薪酬制度对处方习惯的影响尚不清楚.
研究的目的:
- 调查GP薪酬模式与RTIs抗生素处方模式之间的关联.
- 确定服务费 (FFS) 和资本 (CAP) 支付结构是否激励与薪资职位相比,更高的抗生素处方率.
主要方法:
- 利用了2015-2019年挪威登记处的数据,包括RTIs的患者-GP联系.
- 分析了使用统计模型的抗生素处方概率和非基甲基青素 (非PcV) 的选择.
- 在GP内部使用的变化分析以解决选择偏差,重点关注转换薪酬类型的GP.
主要成果:
- 在FFS/CAP模型下的全科医生显示,与雇佣的全科医生相比,对RTIs处方抗生素的概率高12-15%.
- 在处方抗生素时,FSF/CAP全科医生选择非PcV的可能性更高9-11%.
- 对换薪的全科医生的分析显示,FFS/CAP的处方率增加了14%,非PcV选择增加了8%.
结论:
- 医生薪酬计划显著影响抗生素处方行为,FFS/CAP与增加的病率和更广泛的抗生素使用有关.
- 与FFS/CAP模型中的患者保留和时间效率相关的激励措施可能会推动这些处方模式.
- 建议采取政策干预措施,如基于绩效的报酬或根据报酬类型量身定制的处方监测,以促进谨慎使用抗生素.
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