International Health Division, Abt Associates Inc, 4550 Montgomery Avenue, Suite 800N, Bethesda, MD 20814, USA.
Health Policy Plan. 2011 Jul;26 Suppl 1:i53-62. doi: 10.1093/heapol/czr028.
The principal-agent problem in health care asserts that providers, being the imperfect agents of patients, will act to maximize their profits at the expense of the patients' interests. This problem applies especially where professional regulations are lacking and incentives exist to directly link providers' actions to their profits, such as a fee-for-service payment system. The current analysis tests for the existence of the principal-agent problem in the private health market in Vietnam by examining the prescribing patterns of private providers. I show that: (1) private providers were able to induce demand by prescribing more drugs than public providers for a similar illness and patient profile; (2) private providers were significantly more likely to prescribe injection drugs to gain trust among the patients; and (3) patients' education as a source of information and empowerment has enabled them to mitigate the demand inducement by the providers. The hypotheses are supported with evidence from the Vietnam National Health Survey 2001-02, the first and, so far, only comprehensive health survey in the country.
医疗保健中的委托代理问题认为，由于提供者是患者的不完全代理人，他们将以牺牲患者利益为代价来最大化自身利润。在缺乏专业法规且激励机制存在将提供者的行为与利润直接挂钩的情况下，如按服务收费支付系统，该问题尤其适用。本分析通过考察私人提供者的处方模式，检验了越南私人医疗市场中委托代理问题的存在。我发现：（1）私人提供者通过为类似疾病和患者特征开具比公共提供者更多的药物来诱导需求；（2）私人提供者更有可能开具注射药物以获得患者的信任；（3）患者的教育作为一种信息和赋权的来源，使他们能够减轻提供者的需求诱导。这些假设得到了来自 2001-02 年越南国家健康调查的证据的支持，这是该国进行的第一次也是迄今为止唯一一次全面健康调查。
