The effects of competition on medical service provision
The effects of competition on medical service provision
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DOI：
10.1002/hec.3583
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发表时间：
2017-12-01
期刊：
影响因子：
2.1
通讯作者：
Kokot, Johanna
中科院分区：
文献类型：
--
作者：
Brosig-Koch, Jeannette;Hehenkamp, Burkhard;Kokot, Johanna
我们探讨医生之间的竞争如何影响医疗服务的提供。以前的研究表明，如果没有竞争，医生在按人头和按服务收费等支付系统下会偏离患者最佳治疗。尽管竞争可能会减少这些扭曲，但医生通常会随着时间的推移反复相互交流，只有一小部分患者会更换医疗服务提供者。这两种模式都可能阻止竞争朝着理想的方向发展。为了分析竞争的行为效应，我们开发了一个理论基准，然后在受控实验室实验中进行测试。实验条件不同的医生支付和病人的特点。真实的患者从实验中做出的供应决策中受益。研究结果表明，引入竞争可以分别减少供给过剩和供给不足，这与理论预测一致。然而，观察到的效果取决于患者的特征和支付系统。默许串通观察，特别是明显的收费服务支付，但它似乎不太频繁，比相关的实验研究价格竞争。
We explore how competition between physicians affects medical service provision. Previous research has shown that, without competition, physicians deviate from patient-optimal treatment under payment systems like capitation and fee-for-service. Although competition might reduce these distortions, physicians usually interact with each other repeatedly over time and only a fraction of patients switches providers at all. Both patterns might prevent competition to work in the desired direction. To analyze the behavioral effects of competition, we develop a theoretical benchmark that is then tested in a controlled laboratory experiment. Experimental conditions vary physician payment and patient characteristics. Real patients benefit from provision decisions made in the experiment. Our results reveal that, in line with the theoretical prediction, introducing competition can reduce overprovision and underprovision, respectively. The observed effects depend on patient characteristics and the payment system, though. Tacit collusion is observed and particularly pronounced with fee-for-service payment, but it appears to be less frequent than in related experimental research on price competition.