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。对于报酬较低的报销，医生是否会改变入院人数、护理强度或护理质量？我们的研究旨在识别并量化补偿与医生行为之间的因果关系。为了给政策制定者提供合理的建议，将补偿与医生行为之间的因果关系与其他混杂因素分开是至关重要的。该项目创新性地利用了2005年在德国利用现代计量经济学进行的自然实验。2005年4月1日推出的EBM 2000plus(外部专家报销时间表)通常被认为是一次政治失礼，导致外部专家意外削减报销，特别是在德国南部。只有与医院有关联的外部专家(治疗组)才会受到看似合理的外源性薪酬削减高达50%的伤害。在调查期间，医院专科医生(对照组)的报销时间表没有改变。政策制定者设计和构建了医疗保健系统。要做到这一点，政客们需要知道他们是否以及如何引导医疗保健系统中代理人(例如医生)的行为。最优的制度设计需要对卫生保健部门中代理人的行为反应进行透彻的理解和经验估计。

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.