Hadley Jack, Mitchell Jean M
Urban Institute, Center for Studying Health System Change, Washington, DC, USA.
Int J Health Care Finance Econ. 2002 Mar;2(1):37-50. doi: 10.1023/a:1015397413797.
Using survey data collected in 1991 and 1997 from a panel of almost 1,500 physicians, we analyzed the relationship between changes in physicians' incomes, practice autonomy, and satisfaction, and the growth of HMOs and physicians' perceived financial incentives. Both the growth of HMOs and financial incentives to reduce services were significantly related to lower income growth, reductions in practice autonomy, and decreases in satisfaction. Changes in income and autonomy were both positively and significantly related to changes in satisfaction. Controlling for changes in income and autonomy, HMO growth was no longer significantly related to changes in satisfaction. Having a perceived financial incentive to reduce services remained a negative and significant determinant of the change in career satisfaction.
利用1991年和1997年从近1500名医生组成的样本中收集的调查数据，我们分析了医生收入变化、执业自主权和满意度之间的关系，以及健康维护组织（HMO）的增长和医生所感受到的经济激励。HMO的增长以及减少服务的经济激励都与较低的收入增长、执业自主权的降低和满意度的下降显著相关。收入和自主权的变化与满意度的变化均呈显著正相关。在控制了收入和自主权的变化后，HMO的增长与满意度的变化不再显著相关。有减少服务的经济激励仍然是职业满意度变化的一个负面且显著的决定因素。
