家庭医生签约背景下竞争机制引入对医生行为影响的实验研究

目的：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：通过受控实验研究,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。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。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。

Experimental study on the effect of introducing competition mechanism on physicians' behaviors in the context of family doctor contract services

Objective:To testify the effects of the "dual mechanism" of payment systems and competition on behaviors of physicians, and to provide experimental economics evidence for improvement of the family doctor contract system. Methods:Non-competitive and competitive scenarios are designed in controlled laboratory experiments,combining with two payment systems, namely capitation (CAP) and fee-for-service (FFS), to conduct experimental economics research. The random effects model is used to analyze the effect of competition mechanisms on the number of medical treatments and health benefits of patients. Fisher''s combination test is used to explore how physicians'' behaviors are influenced by introducing competition mechanism to different payment systems. Results:Introduction of competition mechanism can relieve insufficiency of supply of services under CAP and excessive supply under FFS.For patients in poor (good) health condition, the competition mechanism changed doctors'' behavior more apparently under CAP (FFS). Comparison between intergroup coefficients of the competition mechanism shows that, compared with "FFS + competition", the loss of patients'' health benefit is less under "CAP + competition" mechanism. The deviation from patient optimal treatment increases when converting the competition scenario to a no-competition one. Conclusion:The quality of family medical service is improved by introducing competition mechanism, and the dual mechanism design of CAP combined with competition is more advantageous.