医院人事制度与医生劳动力市场结构：基于买方垄断模型的分析

推动公立医院人事制度改革是实现健康中国建设必不可少的环节,而制定科学有效的改革政策，离不开对医生劳动力市场结构和医院人事制度影响机制的严谨分析。利用某省会城市医院统计调查数据，本课题试图检验和测量医生劳动力市场的买方垄断势力，并探索劳动力市场结构的影响因素及其机制，有效填补文献中实证证据的不足。通过构造薪资负加成的指标，课题将结合简化式和结构模型两种思路以及工具变量和控制函数两种方法，精确测量医生劳动力市场买方垄断势力。另一方面，本课题将通过双重差分法识别“医师多点执业”等人事制度改革对医生劳动力市场买方垄断势力的影响，结合异质性分析和模型建立分析医院人事制度对医生劳动力市场结构的影响机制。最后，课题将量化分析劳动力市场买方垄断可能导致的社会福利收益和成本，综合考虑其有助于控制医疗支出的正面影响，以及其导致医生数量低于社会最优等负面影响，结合国际经验比较后，提供医院人事制度改革的政策建议。

Understanding the physician labor market structure and its relationship with the hospital personnel system is essential for the ongoing health care reform in China. Using a unique hospital-level data set in a major provincial city, this project aims to quantitatively estimate the labor monopsony power for physicians and explore the impact of the hospital personnel system on the labor market structure. Specifically, the project will utilize the instrumental variable approach in the reduced-form analysis and the control function approach in the structural model analysis to calculate the wage markdown, which is an accurate measure of labor monopsony power. Moreover, the project will use the difference-in-differences method to identify the effect of personnel system reforms, such as the pilot scheme of multi-site practice for physicians, on the labor market structure. Based on the empirical evidence of heterogeneous labor monopsony power and the effects of the personnel system reforms, the project will theoretically discuss the mechanism how the hospital personnel system affects the physician labor monopsony power. Meanwhile, the project will conduct the welfare analysis to quantify the social benefit and cost of the existing labor monopsony power. Through international comparison of health care systems, the project will finally provide policy implications and suggestions.