Dong H, Bogg L, Rehnberg C, Diwan V
Shanghai Medical University.
Int J Technol Assess Health Care. 1999 Fall;15(4):686-98.
To describe effects of health financing on providers' opinions and prescribing behavior in rural China.
A multi-stage sampling procedure was used to select county, township, and village health care facilities. A total of 1,064 health care providers in county, township, and village health care facilities in six counties in central China were randomly selected and surveyed during one week by written questionnaire.
Patient's health financing systems (insurance or out-of-pocket payment), financing methods for health facilities (general budget or fee for service), and payment methods for providers (salary or bonus) influenced provider prescribing. Bonuses could improve the quality of health care, but could also be an incentive to prescribe more drugs or more expensive drugs and other services. The providers were of the view that patients' health financing and ability to pay were the main determinants of the type of treatment. Insured patients could have more access to expensive drugs, referred to specialized health care facilities, and have a higher cure rate (according to the doctor's opinion) for tuberculosis. Most of the clinical doctors said that they prescribed more expensive antibiotics for insured patients and changed prescriptions according to patients' demands, financial ability, and health financing systems in the treatment of some diseases, such as chronic bronchitis, tuberculosis, and hypertension.
The empirical data suggest that the main factor influencing provider prescribing behavior is the economic incentives in relation to health care financing for both health care providers and consumers.
描述卫生筹资对中国农村地区医疗服务提供者观点及处方行为的影响。
采用多阶段抽样程序选取县、乡、村三级医疗卫生机构。在中国中部六个县的县、乡、村医疗卫生机构中，随机抽取1064名医疗服务提供者，并在一周内通过书面问卷进行调查。
患者的卫生筹资体系（保险或自费支付）、医疗卫生机构的筹资方式（一般预算或服务收费）以及医疗服务提供者的支付方式（工资或奖金）会影响医疗服务提供者的处方行为。奖金可以提高医疗服务质量，但也可能成为开具更多药品或更昂贵药品及其他服务的诱因。医疗服务提供者认为，患者的卫生筹资和支付能力是治疗类型的主要决定因素。参保患者能够更容易获得昂贵药品，被转诊至专科医疗机构，并且（根据医生的观点）肺结核治愈率更高。大多数临床医生表示，在治疗某些疾病（如慢性支气管炎、肺结核和高血压）时，他们会为参保患者开具更昂贵的抗生素，并根据患者的需求、经济能力和卫生筹资体系更改处方。
实证数据表明，影响医疗服务提供者处方行为的主要因素是医疗服务提供者和消费者在医疗保健筹资方面的经济激励措施。
