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时间就是金钱:1996-2005 年机会成本与医生提供慈善医疗服务

Time is money: opportunity cost and physicians' provision of charity care 1996-2005.

机构信息

Cecil G Sheps Center for Health Services Research, The University of North Carolina, 725 Martin Luther King Jr. Blvd, CB#7590, Chapel Hill, NC 27599, USA.

出版信息

Health Serv Res. 2010 Dec;45(6 Pt 1):1670-92. doi: 10.1111/j.1475-6773.2010.01139.x.

Abstract

OBJECTIVE

To test whether physicians' provision of charity care depends on their hourly wage.

DATA SOURCES

Secondary data from four rounds of the Community Tracking Study (CTS) Physician Survey (1996-2005). Data are nationally representative of nonfederal office- and hospital-based physicians spending at least 20 hours per week on patient care.

STUDY DESIGN

A two-part model with site-level fixed effects, time trend variables, and site-year interactions is used to model the relationship between physicians' hourly wage and both their decision to provide any charity care and the amount of charity care provided. Salaried and nonsalaried physicians are modeled separately.

DATA COLLECTION/EXTRACTION METHODS: Data from each round of the CTS were merged into a single cross-sectional file with 38,087 physician-year observations.

PRINCIPAL FINDINGS

The association between physician's hourly wage and the likelihood of providing charity care is positive for salaried physicians and negative for nonsalaried physicians. Among physicians providing any charity care, hourly wage is positively associated with the amount of charity care provided regardless of salaried status. Practice characteristics are also significant.

CONCLUSIONS

The financial considerations of salaried physicians differ significantly from those of nonsalaried physicians in the decision to provide charity care, but factor similarly into the amount of charity care provided.

摘要

目的

检验医师提供慈善医疗服务是否取决于其时薪。

资料来源

社区追踪研究(CTS)医师调查的四轮(1996-2005 年)次级资料。该资料为全国范围内非联邦办公室和医院的每周至少有 20 小时用于患者护理的执业医师提供了代表性数据。

研究设计

采用两部分模型,包含地点固定效应、时间趋势变量和地点-年份交互作用,以模型化医师时薪与提供任何慈善医疗服务的决策以及提供的慈善医疗服务量之间的关系。对受薪医师和非受薪医师分别进行建模。

资料收集/提取方法:将 CTS 每轮的资料合并到一个具有 38087 名医师-年观测值的单一横断面档案中。

主要发现

受薪医师的时薪与提供慈善医疗服务的可能性之间存在正相关关系,而非受薪医师则存在负相关关系。在提供任何慈善医疗服务的医师中,无论受薪状况如何,时薪与提供的慈善医疗服务量呈正相关。执业特征也具有重要意义。

结论

在提供慈善医疗服务的决策中,受薪医师的财务考虑与非受薪医师有显著差异,但对提供的慈善医疗服务量的影响因素相似。

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