How do physicians respond to financial incentives? Evidence from a natural experiment in Germany.

这个项目解决了医生如何应对经济激励的问题。医生是否会改变入院人数、护理强度或护理质量，以应对报酬较低的报销？本研究的目的是确定和量化医疗费用报销与医生行为之间的因果关系，将医疗费用报销与医生行为之间的因果关系与其他混杂因素分离开来，为政策制定者提供合理的建议。该项目创新性地利用了2005年在德国进行的一项使用现代计量经济学的自然实验。2005年4月1日引入的EBM 2000 plus（外部专家报销计划）通常被认为是一种政治失礼，导致了外部专家的意外报销削减，特别是在德国南部。只有与医院有联系的外部专家（治疗组）受到了高达50%的合理的外部支付削减的伤害。医院专家（对照组）的报销时间表在调查期间没有变化。政策制定者设计和构建医疗保健系统。要做到这一点，政治家需要知道他们是否以及如何能够引导医疗保健系统中代理人（例如医生）的行为。一个最佳的制度设计需要一个透彻的理解和经验估计的代理人在医疗保健部门的行为反应。

This project addresses the question how physicians respond to financial incentives. Do physicians alter the number of admissions, intensity of care, or quality of care in response to less remunerative reimbursements? Our study aims at identifying as well as quantifying the causal link between reimbursements and physician behavior.To give sound recommendations to policy-makers, it is of vital importance to isolate the causal relationship between reimbursements and physician behavior from other confounding factors. This project innovatively utilizes a natural experiment that took place in Germany in 2005 using modern econometrics.The introduction of the EBM 2000plus (reimbursement schedule for external specialists) on April 1, 2005 is usually regarded as a political faux pas that led to unintended reimbursement cuts for external specialists, particularly in the South of Germany. Only external specialists with a hospital affiliation (treatment group) got hurt by plausibly exogenous payment cuts of up to 50 percent. The reimbursement schedule for hospital specialists (control group) did not change in the period under investigation.Policy-makers design and structure the health care system. To do so, politicians need to know whether and how they can steer the behavior of agents in the health care system (e.g. physicians). An optimal institutional design demands a thorough understanding and empirical estimate of the behavioral responses of the agents in the health care sector.