BonnEconLab – Laboratory for Experimental Economics, University of Bonn, Adenauerallee 24-42, D-53113 Bonn, Germany.
J Health Econ. 2011 Jul;30(4):637-46. doi: 10.1016/j.jhealeco.2011.05.001. Epub 2011 May 11.
Understanding how physicians respond to incentives from payment schemes is a central concern in health economics research. We introduce a controlled laboratory experiment to analyse the influence of incentives from fee-for-service and capitation payments on physicians' supply of medical services. In our experiment, physicians choose quantities of medical services for patients with different states of health. We find that physicians provide significantly more services under fee-for-service than under capitation. Patients are overserved under fee-for-service and underserved under capitation. However, payment incentives are not the only motivation for physicians' quantity choices, as patients' health benefits are of considerable importance as well. We find that patients in need of a high (low) level of medical services receive larger health benefits under fee-for-service (capitation).
了解医生如何应对支付方案中的激励措施是卫生经济学研究的核心关注点。我们引入了一项受控实验室实验，以分析按服务收费和总额预付制支付方式中的激励措施对医生提供医疗服务数量的影响。在我们的实验中，医生为不同健康状况的患者选择医疗服务数量。我们发现，与按人头付费相比，按服务收费时医生提供的服务明显更多。按服务收费时患者过度服务，而按人头付费时则服务不足。然而，支付激励并不是医生数量选择的唯一动机，因为患者的健康效益也非常重要。我们发现，需要高水平（低水平）医疗服务的患者在按服务收费（总额预付制）下获得的健康效益更大。
