Conrad Douglas A, Christianson Jon B
University of Washington, USA.
Med Care Res Rev. 2004 Sep;61(3 Suppl):37S-68S. doi: 10.1177/1077558704266770.
This article addresses the impact of financial incentives on physician behavior, focusing on quality of care. Changing market conditions, evolving social forces, and continuing organizational evolution in health services have raised societal awareness and expectations concerning quality. This article proceeds in four parts. First, the authors place financial incentives in the context of broader forces shaping the quality of physician services. Second, the article reviews the literature on financial incentive effects on physician behavior. Third, a simple net income maximization model of physician choices is presented, from which are derived formal hypotheses regarding the effect of financial incentives on physician choices of quality per unit of physician service and the quantity of services per patient. The model is extended qualitatively to offer further hypotheses and research directions. Finally, gaps and limitations of the model and of the extant empirical research are articulated, and additional researchable questions are posed.
本文探讨经济激励措施对医生行为的影响，重点关注医疗质量。不断变化的市场环境、不断演变的社会力量以及卫生服务领域持续的组织变革，提高了社会对医疗质量的认识和期望。本文分为四个部分。首先，作者将经济激励措施置于塑造医生服务质量的更广泛力量的背景下。其次，本文回顾了关于经济激励措施对医生行为影响的文献。第三，提出了一个简单的医生选择净收入最大化模型，从中得出关于经济激励措施对医生每单位服务质量选择和每位患者服务数量影响的正式假设。该模型进行了定性扩展，以提供进一步的假设和研究方向。最后，阐述了该模型和现有实证研究的差距与局限性，并提出了其他可研究的问题。
