Utrecht School of Economics, Utrecht University, Janskerkhof 12, 3512BL Utrecht, The Netherlands. :
J Health Econ. 2010 Jan;29(1):124-36. doi: 10.1016/j.jhealeco.2009.11.006. Epub 2009 Dec 14.
This paper distinguishes between two scenarios for the physician-patient encounter. In the cure scenario, the patient does not know whether a loss can be recovered. In the prevention scenario, the patient faces a threat but does not know whether this threat is real enough to justify preventive action. The patient wants to induce the physician both to give an accurate diagnosis and to put appropriate effort into cure or prevention. It is shown that in the cure scenario, a contingent fee solves both these incentive problems. In the prevention scenario, however, putting up with low effort makes it easier to get an accurate diagnosis, and the use of contingent fees should be limited. These results are interpreted as providing a rationale for observed exceptions to legal and ethical restrictions on the use of contingent fees. Indeed, such exceptions are often granted for cases that fit the cure scenario.
本文区分了医患接触的两种情况。在治疗场景中，患者不知道损失是否可以挽回。在预防场景中，患者面临威胁，但不知道这种威胁是否足以采取预防措施。患者希望诱导医生做出准确的诊断，并为治疗或预防投入适当的努力。结果表明，在治疗场景中，按结果付费可以解决这两个激励问题。然而，在预防场景中，容忍低努力程度可以更容易地获得准确的诊断，并且应限制使用按结果付费。这些结果可以解释为，为观察到的对使用按结果付费的法律和道德限制的例外情况提供了依据。事实上，这种例外情况通常适用于符合治疗情况的案例。
