Godager Geir, Iversen Tor, Ma Ching-To Albert
Institute of Health Management and Health Economics, University of Oslo, Oslo, Norway.
Int J Health Care Finance Econ. 2009 Mar;9(1):39-57. doi: 10.1007/s10754-008-9046-y. Epub 2008 Jul 6.
We model physicians as health care professionals who care about their services and monetary rewards. These preferences are heterogeneous. Different physicians trade off the monetary and service motives differently, and therefore respond differently to incentive schemes. Our model is set up for the Norwegian health care system. First, each private practice physician has a patient list, which may have more or less patients than he desires. The physician is paid a fee-for-service reimbursement and a capitation per listed patient. Second, a municipality may obligate the physician to perform 7.5 h/week of community services. Our data are on an unbalanced panel of 435 physicians, with 412 physicians for the year 2002, and 400 for 2004. A physician's amount of gross wealth and gross debt in previous periods are used as proxy for preferences for community service. First, for the current period, accumulated wealth and debt are predetermined. Second, wealth and debt capture lifestyle preferences because they correlate with the planned future income and spending. The main results show that both gross debt and gross wealth have negative effects on physicians' supply of community health services. Gross debt and wealth have no effect on fee-for-service income per listed person in the physician's practice, and positive effects on the total income from fee-for-service. The higher income from fee-for-service is due to a longer patient list. Patient shortage has no significant effect on physicians' supply of community services, a positive effect on the fee-for-service income per listed person, and a negative effect on the total income from fee for service. These results support physician preference heterogeneity.
我们将医生建模为关心自身服务和金钱回报的医疗保健专业人员。这些偏好是异质性的。不同的医生对金钱和服务动机的权衡方式不同，因此对激励计划的反应也不同。我们的模型是针对挪威医疗保健系统建立的。首先，每位私人执业医生都有一份患者名单，其患者数量可能多于或少于他的期望。医生按服务收费获得报销，并从每位在册患者那里获得一笔人头费。其次，市政府可能会要求医生每周提供7.5小时的社区服务。我们的数据来自一个由435名医生组成的非平衡面板，2002年有412名医生，2004年有400名医生。医生在前几个时期的总财富和总债务数额被用作社区服务偏好的代理变量。首先，对于当期而言，累计财富和债务是预先确定的。其次，财富和债务反映了生活方式偏好，因为它们与计划中的未来收入和支出相关。主要结果表明，总债务和总财富对医生提供社区卫生服务均有负面影响。总债务和财富对医生执业中每位在册人员的按服务收费收入没有影响，但对按服务收费的总收入有积极影响。按服务收费收入较高是因为患者名单更长。患者短缺对医生提供社区服务没有显著影响，对每位在册人员的按服务收费收入有积极影响，对按服务收费的总收入有负面影响。这些结果支持了医生偏好的异质性。
