School of Public Health, University of California, Berkeley, United States; Department of Economics, University of California, Santa Barbara, United States.
Healthc (Amst). 2017 Sep;5(3):125-128. doi: 10.1016/j.hjdsi.2016.04.009. Epub 2016 May 17.
Payment reform has been at the forefront of the movement toward higher-value care in the U.S. health care system. A common belief is that volume-based incentives embedded in fee-for-service need to be replaced with value-based payments. While this belief is well-intended, value-based payment also contains perverse incentives. In particular, behavioral economists have identified several features of individual decision making that reverse some of the typical recommendations for inducing desirable behavior through financial incentives. This paper discusses the countervailing incentives associated with four behavioral economic concepts: loss aversion, relative social ranking, inertia or status quo bias, and extrinsic vs. intrinsic motivation.
支付方式改革一直处于美国医疗体系向更具价值的医疗服务发展的前沿。人们普遍认为，按服务项目收费中所嵌入的基于数量的激励措施需要用基于价值的支付方式来取代。尽管这种信念是出于好意，但基于价值的支付也包含有不良激励。具体来说，行为经济学家已经确定了个体决策的几个特征，这些特征颠覆了通过经济激励来诱导理想行为的一些典型建议。本文讨论了与四个行为经济学概念相关的补偿性激励：损失厌恶、相对社会排名、惯性或现状偏见，以及外在动机与内在动机。
