Incentives and Performance of Healthcare Professionals
Incentives and Performance of Healthcare Professionals
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医疗保健专业人员的激励和绩效
DOI：
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
M. Chalkley
中科院分区：
文献类型：
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作者：
M. Chalkley
长期以来，经济学家一直将医疗保健视为经济活动的一个独特而具有挑战性的领域，因为医疗保健专业人员（HCPs）的专业知识和运作的相对薄弱的市场机制。这就把动机和激励如何影响绩效作为研究的中心。与其他领域一样，经济学家倾向于关注金融机制，因此在考虑hcp时，他们研究了现有的支付系统和潜在的替代方案如何影响行为。长期以来，人们一直担心简单的安排，如按服务收费、按人头支付和工资支付可能会导致业绩不佳，这导致对薪酬与业绩之间的联系进行广泛的理论和实证调查。在经济学中，契约理论和机制设计被广泛而迅速地应用于研究这些问题。该理论强调了解决医疗保健中大量存在的信息不对称的激励方案的潜在好处和风险。这类方案在实践中得到了一些扩展，但在应用中往往受到限制，其有效性的证据也参差不齐。理解为什么在概念和应用之间存在这种相对较大的差距，可以指导未来的研究可以最有效地集中在哪里。
Economists have long regarded healthcare as a unique and challenging area of economic activity on account of the specialized knowledge of healthcare professionals (HCPs) and the relatively weak market mechanisms that operate. This places a consideration of how motivation and incentives might influence performance at the center of research. As in other domains economists have tended to focus on financial mechanisms and when considering HCPs have therefore examined how existing payment systems and potential alternatives might impact on behavior. There has long been a concern that simple arrangements such as fee-for-service, capitation, and salary payments might induce poor performance, and that has led to extensive investigation, both theoretical and empirical, on the linkage between payment and performance. An extensive and rapidly expanded field in economics, contract theory and mechanism design, had been applied to study these issues. The theory has highlighted both the potential benefits and the risks of incentive schemes to deal with the information asymmetries that abound in healthcare. There has been some expansion of such schemes in practice but these are often limited in application and the evidence for their effectiveness is mixed. Understanding why there is this relatively large gap between concept and application gives a guide to where future research can most productively be focused.