Bessho Shun-ichiro, Ohkusa Yasushi
Graduate School of Economics, The University of Tokyo.
Health Care Manag Sci. 2006 Feb;9(1):5-18. doi: 10.1007/s10729-006-6276-8.
We examine the length of time between when an individual feels sick and when he/she visits a doctor using survival analysis to capture the dynamic aspects of this behavior. If the disease is light, actions such as OTC medicine or sick leave are alternatives to visiting a clinic or a hospital immediately. The timing of the visit depends only the person's decision, not on a doctor's, so we can limit discussion to the effect of ex-post moral hazard excluding physician induced demand. Participants were asked to keep a log of illness-related behavior such as dates of episodes, subjective symptoms, sick leaves, and medical treatment at hospitals. Neither the copayment rate nor access cost had a significant effect on the behavior of visiting a doctor, whereas available alternatives delay the timing of a visiting. Severe symptoms and fever hastened the time. The results suggest that the traditional argument about ex-post moral hazard is somewhat misleading.
我们使用生存分析来研究个体感到不适与就医之间的时间长度，以捕捉这种行为的动态方面。如果疾病较轻，诸如使用非处方药或请病假等行为可替代立即前往诊所或医院就诊。就诊时间仅取决于个人的决定，而非医生的决定，因此我们可以将讨论局限于排除医生诱导需求后的事后道德风险的影响。参与者被要求记录与疾病相关的行为，如发病日期、主观症状、病假以及在医院的治疗情况。自付费用率和就诊成本对就医行为均无显著影响，而可用的替代方案会延迟就诊时间。严重症状和发烧会加快就诊时间。结果表明，关于事后道德风险的传统观点存在一定误导性。
