Palo Alto Medical Foundation Research Institute, Palo Alto, CA 94301, USA.
Health Econ. 2012 Apr;21(4):457-76. doi: 10.1002/hec.1726. Epub 2011 Mar 27.
A physician's own time is a scarce resource in primary care, and the physician must constantly evaluate the gain from spending more time with the current patient against moving to address the health-care needs of the next. We formulate and test two alternative hypotheses. The first hypothesis is based on the premise that with time so scarce, physicians equalize the marginal value of time across patients. The second, alternative hypothesis states that physicians allocate the same time to each patient, regardless of how much the patient benefits from the time at the margin. For our empirical work, we examine the presence of a sharply increasing subjective shadow price of time around the 'target' time using video recordings of 385 visits by elderly patients to their primary care physician. We structure the data at the 'topic' level and find evidence consistent with the alternative hypothesis. Specifically, time elapsed within a visit is a very strong determinant of the current topic being the 'last topic'. This finding implies the physician's shadow price of time is rising during the course of a visit. We consider whether dislodging a target-time mentality from physicians (and patients) might contribute to more productive primary care practice.
医生自己的时间在初级保健中是一种稀缺资源,医生必须不断评估花更多时间在当前患者身上的收益,以满足下一个患者的医疗需求。我们提出并检验了两个替代假设。第一个假设基于这样一个前提,即由于时间如此稀缺,医生会使患者之间的时间边际价值均等化。第二个替代假设则表明,医生会为每个患者分配相同的时间,而不管患者从边际时间中受益多少。在我们的实证工作中,我们使用老年患者就诊于初级保健医生的 385 次视频记录,来检验在“目标”时间附近是否存在时间主观影子价格急剧上升的情况。我们在“主题”层面上构建数据,并找到了与替代假设一致的证据。具体来说,就诊过程中花费的时间是当前主题是否为“最后一个主题”的一个很强的决定因素。这一发现意味着,在就诊过程中,医生的时间影子价格正在上升。我们考虑是否可以让医生(和患者)摆脱目标时间的心态,从而有助于提高初级保健的效率。