Department of Health Organization, Policy and Economics, CAPHRI, Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Int J Environ Res Public Health. 2010 Jun;7(6):2708-25. doi: 10.3390/ijerph7062708. Epub 2010 Jun 23.
This paper reviews the existing empirical micro-level models of demand for out-patient physician services where the size of patient payment is included either directly as an independent variable (when a flat-rate co-payment fee) or indirectly as a level of deductibles and/or co-insurance defined by the insurance coverage. The paper also discusses the relevance of these models for the assessment of patient payment policies. For this purpose, a systematic literature review is carried out. In total, 46 relevant publications were identified. These publications are classified into categories based on their general approach to demand modeling, specifications of data collection, data analysis, and main empirical findings. The analysis indicates a rising research interest in the empirical micro-level models of demand for out-patient physician services that incorporate the size of patient payment. Overall, the size of patient payments, consumer socio-economic and demographic features, and quality of services provided emerge as important determinants of demand for out-patient physician services. However, there is a great variety in the modeling approaches and inconsistencies in the findings regarding the impact of price on demand for out-patient physician services. Hitherto, the empirical research fails to offer policy-makers a clear strategy on how to develop a country-specific model of demand for out-patient physician services suitable for the assessment of patient payment policies in their countries. In particular, theoretically important factors, such as provider behavior, consumer attitudes, experience and culture, and informal patient payments, are not considered. Although we recognize that it is difficult to measure these factors and to incorporate them in the demand models, it is apparent that there is a gap in research for the construction of effective patient payment schemes.
本文回顾了现有的门诊医师服务需求的实证微观经济模型，其中患者支付的费用大小既可以直接作为自变量（当采用固定共付额时），也可以通过保险范围定义的免赔额和/或共付额间接表示。本文还讨论了这些模型对患者支付政策评估的相关性。为此，进行了系统的文献综述。总共确定了 46 篇相关出版物。这些出版物根据其需求建模的一般方法、数据收集规范、数据分析和主要实证发现进行分类。分析表明，人们对纳入患者支付规模的门诊医师服务需求实证微观经济模型的研究兴趣日益浓厚。总体而言，患者支付的大小、消费者的社会经济和人口特征以及提供的服务质量是门诊医师服务需求的重要决定因素。然而，在建模方法上存在很大差异，关于价格对门诊医师服务需求的影响的研究结果也不一致。迄今为止，实证研究未能为决策者提供明确的策略，以制定适合评估其国家患者支付政策的特定国家的门诊医师服务需求模型。特别是，没有考虑到提供者行为、消费者态度、经验和文化以及非正式患者支付等理论上重要的因素。尽管我们认识到很难衡量这些因素并将其纳入需求模型，但显然在构建有效的患者支付方案方面存在研究差距。
