Nassiri Abdelhak, Rochaix Lise
University of Western Brittany, France.
Health Econ. 2006 Jan;15(1):49-64. doi: 10.1002/hec.1012.
Do Primary Care Physicians (PCPs) react strategically to financial incentives and if so how? To address this question, we follow a quasi-natural experiment in Quebec, using a panel system technique. In so doing, we both correct for underestimation biases in earlier time series findings and generate new results on the issue of complementarity/substitution between consultations with varying levels of technicality. Under both techniques, we show that PCPs are sensitive to the enforcement and subsequent temporary removals of expenditure caps and more generally, to changes in consultations' relative prices over time. These results support the existence of a discretionary power over the choice of consultation, PCPs increasing strategically the number of the more technical (and therefore more lucrative) consultations when pressed to defend their income. This finding for primary care parallels the now well-established DRG creep in hospitals. The panel system approach offers a better account of the complexity surrounding PCPs' decision-making process. In particular, it successfully addresses issues of physician heterogeneity, jointness between consultations and temporal breaks and generates robust estimates of PCPs volume and quality reactions to regulatory changes.
初级保健医生（PCP）会对经济激励做出策略性反应吗？如果会，又是如何反应的？为回答这个问题，我们在魁北克进行了一项准自然实验，采用面板系统技术。这样做，我们既纠正了早期时间序列研究中的低估偏差，又得出了关于不同技术水平会诊之间互补性/替代性问题的新结果。在这两种技术下，我们都表明初级保健医生对支出上限的实施及随后的临时取消很敏感，更普遍地说，对会诊相对价格随时间的变化很敏感。这些结果支持了在会诊选择上存在自由裁量权的观点，即当面临捍卫收入的压力时，初级保健医生会策略性地增加技术要求更高（因而利润更高）的会诊次数。这一关于初级保健的发现与医院中现已确立的诊断相关分组（DRG）费用上涨现象类似。面板系统方法能更好地解释初级保健医生决策过程的复杂性。特别是，它成功解决了医生异质性、会诊之间的关联性和时间断点问题，并对初级保健医生对监管变化的数量和质量反应产生了稳健的估计。
