Overtreatment and benevolent provider moral hazard: Evidence from South African doctors
Overtreatment and benevolent provider moral hazard: Evidence from South African doctors
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DOI：
10.1016/j.jdeveco.2022.102917
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发表时间：
2022-09-01
影响因子：
5
通讯作者：
Blaauw, Duane
中科院分区：
文献类型：
--
作者：
Lagarde, Mylene;Blaauw, Duane
过度治疗在卫生领域很普遍，对病人、卫生系统和公共卫生可能造成可怕的后果。当提供者不承担治疗费用（道德风险）时，甚至他们不从中获利（即仁慈的提供者），也可能会助长这种行为。我们测试这一假设，创造一个外生的变化，在南非的私人医生所面临的激励。我们发现，供应商的道德风险没有影响过度治疗的数量，但燃料过度治疗的成本。相比之下，当医生承担边际治疗成本时，他们会选择更便宜的药物。虽然这些结果表明，提供者的道德风险有助于在初级保健过度治疗，我们认为其他合理的渠道，如对高质量的药物或市场细分的感知需求的反应。我们讨论了潜在的供应方成本分摊激励措施，以减少在未来的南非卫生系统改革的效率低下的范围。
Overtreatment is widespread in health, with potentially dire consequences for patients, health systems and public health. It may be fueled by providers when they do not bear the cost of treatment (moral hazard), even they do not profit financially from it (i.e. benevolent providers). We test this hypothesis by creating an exogeneous change in the incentives faced by private doctors in South Africa. We find that provider moral hazard has no effect on overtreatment in volume but fuels overtreatment in cost. By contrast, when they bear the marginal treatment cost, doctors choose cheaper drug. While these results suggest that provider moral hazard contributes to overtreatment in primary care, we consider other plausible channels, such as responses to a perceived demand for high-quality drugs or market segmentation. We discuss the potential scope for supply-side cost-sharing incentives to reduce inefficiency in future health system reforms in South Africa.