Smieliauskas Fabrice
Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA.
Health Econ. 2016 Jun;25(6):723-39. doi: 10.1002/hec.3177. Epub 2015 Apr 5.
Financial relationships between physicians and industry are vital to biomedical innovation yet create the potential for conflicts of interest in medical practice. I consider an inducement model of the role of financial relationships in health care markets, where consulting payments induce physicians to use more devices of the firms that sponsor them. To test the model, I exploit a policy shock, whereby government monitoring of payments to joint replacement surgeons resulted in declines of over 60% in both total payments and in the number of physicians receiving payments from 2007 to 2008. Using hospital discharge data from three states, I find that the loss of payments leads physicians to switch 7 percentage points of their device utilization from their sponsoring firms' devices to other firms' devices, an effect which is concentrated among surgeons with low switching costs. These results offer support for the inducement model. I also find evidence of an increase in medical productivity following the policy intervention, which suggests conditions under which regulation of financial relationships would be socially beneficial. Copyright © 2015 John Wiley & Sons, Ltd.
医生与行业之间的财务关系对生物医学创新至关重要，但在医疗实践中也可能引发利益冲突。我考虑了一种关于财务关系在医疗保健市场中作用的诱导模型，即咨询费用促使医生更多地使用赞助他们的公司的设备。为了检验该模型，我利用了一项政策冲击，即政府对关节置换外科医生报酬的监管导致从2007年到2008年，总报酬以及获得报酬的医生数量均下降了60%以上。利用三个州的医院出院数据，我发现报酬的减少促使医生将其设备使用的7个百分点从赞助公司的设备转向其他公司的设备，这一效应集中在转换成本较低的外科医生中。这些结果为诱导模型提供了支持。我还发现了政策干预后医疗生产率提高的证据，这表明了对财务关系进行监管在何种情况下会对社会有益。版权所有© 2015约翰·威利父子有限公司。
