Time is up: increasing shadow price of time in primary-care office visits.
Time is up: increasing shadow price of time in primary-care office visits.
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DOI：
10.1002/hec.1726
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发表时间：
2012-04
期刊：
影响因子：
2.1
通讯作者：
McGuire, Thomas
中科院分区：
文献类型：
--
作者：
Tai-Seale, Ming;McGuire, Thomas
在初级保健中，医生自己的时间是一种稀缺资源，医生必须不断评估在当前患者身上花费更多时间的收益，而不是转移到下一个患者的卫生保健需求上。我们提出并检验了两个可供选择的假设。第一个假设是基于这样一个前提：在时间如此稀缺的情况下，医生会在病人身上平衡时间的边际价值。第二种假设是，医生给每个病人分配相同的时间，而不管病人从边际时间中获益多少。对于我们的实证工作，我们使用385名老年患者对初级保健医生的访问视频记录，检查了在“目标”时间周围急剧增加的主观时间影子价格的存在。我们在“主题”层面构建数据，并找到与备选假设一致的证据。具体来说，访问期间所花费的时间是当前主题是否是“最后一个主题”的重要决定因素。这一发现表明，在就诊过程中，医生的时间影子价格正在上升。我们考虑是否从医生（和患者）转移目标时间的心态可能有助于更有效的初级保健实践。版权所有©2011 John Wiley & Sons， Ltd
A physician's own time is a scarce resource in primary care, and the physician must constantly evaluate the gain from spending more time with the current patient against moving to address the health‐care needs of the next. We formulate and test two alternative hypotheses. The first hypothesis is based on the premise that with time so scarce, physicians equalize the marginal value of time across patients. The second, alternative hypothesis states that physicians allocate the same time to each patient, regardless of how much the patient benefits from the time at the margin. For our empirical work, we examine the presence of a sharply increasing subjective shadow price of time around the ‘target’ time using video recordings of 385 visits by elderly patients to their primary care physician. We structure the data at the ‘topic’ level and find evidence consistent with the alternative hypothesis. Specifically, time elapsed within a visit is a very strong determinant of the current topic being the ‘last topic’. This finding implies the physician's shadow price of time is rising during the course of a visit. We consider whether dislodging a target‐time mentality from physicians (and patients) might contribute to more productive primary care practice. Copyright © 2011 John Wiley & Sons, Ltd.
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