THE EFFECTS OF INTRODUCING MIXED PAYMENT SYSTEMS FOR PHYSICIANS: EXPERIMENTAL EVIDENCE
THE EFFECTS OF INTRODUCING MIXED PAYMENT SYSTEMS FOR PHYSICIANS: EXPERIMENTAL EVIDENCE
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DOI：
10.1002/hec.3292
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发表时间：
2017-02-01
期刊：
影响因子：
2.1
通讯作者：
Wiesen, Daniel
中科院分区：
文献类型：
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作者：
Brosig-Koch, Jeannette;Hennig-Schmidt, Heike;Wiesen, Daniel
混合支付系统已成为通过按服务收费和按人头付费来支付医生的一个突出替代方案。虽然理论表明，混合支付系统是上级，因果关系的影响，医生的行为时，引入混合系统没有很好地理解经验。我们系统地分析了按服务收费、按人头付费和混合支付制度对医生服务提供的影响。在受控的实验室环境中，我们实施了支付方法的外生变化。医学和非医学专业的学生在实验室的医生的角色（N = 213）选择的医疗服务量影响病人的健康实验室外。行为数据显示，医疗服务收费下的显着过度提供服务和显着不足，根据人头，虽然低于预期的假设利润最大化。引入混合支付系统可显著减少偏离患者最佳治疗的情况。虽然医学生往往更耐心，我们的结果适用于医学和非医学生。对激励系统的反应可以用一个捕捉个人利他主义的行为模型来解释。特别是，我们发现支持利他主义在服务提供中发挥作用，可以部分缓解代理问题，但利他主义是异质的人口。版权所有（C）2015约翰威利父子有限公司
Mixed payment systems have become a prominent alternative to paying physicians through fee-for-service and capitation. While theory shows mixed payment systems to be superior, causal effects on physicians' behavior when introducing mixed systems are not well understood empirically. We systematically analyze the influence of fee-for-service, capitation, and mixed payment systems on physicians' service provision. In a controlled laboratory setting, we implement an exogenous variation of the payment method. Medical and non-medical students in the role of physicians in the lab (N = 213) choose quantities of medical services affecting patients' health outside the lab. Behavioral data reveal significant overprovision of medical services under fee-for-service and significant underprovision under capitation, although less than predicted when assuming profit maximization. Introducing mixed payment systems significantly reduces deviations from patient-optimal treatment. Although medical students tend to be more patient regarding, our results hold for both medical and non-medical students. Responses to incentive systems can be explained by a behavioral model capturing individual altruism. In particular, we find support that altruism plays a role in service provision and can partially mitigate agency problems, but altruism is heterogeneous in the population. Copyright (C) 2015 John Wiley & Sons, Ltd.