Department of Health Promotion and Development, University of Bergen, Bergen, Norway.
Department of Economics, University of Oslo, Oslo, Norway.
Health Econ. 2020 Jul;29(7):778-789. doi: 10.1002/hec.4019. Epub 2020 Apr 13.
In social insurance systems that grant workers paid sick leave, physicians act as gatekeepers, supposedly granting sickness certificates to the sick and not to shirkers. Previous research has emphasized the physician's superior ability to judge patients' need of treatment and potential collusion with the patient vis-á-vis an insurer. What is less well understood is the role of patients' private information. We explore the case where patients have private information about the presence of nonverifiable symptoms. Anyone can then claim to experience such symptoms, reducing physicians' ability to distinguish between sick patients and shirkers. Doubting a patients' reported symptoms may prevent good medical treatment of the truly sick. We show that for all parameter values, the Bayesian Nash equilibrium is that some physicians trust all claims of nonverifiable symptoms, sicklisting shirkers as well as sick; for many values, every physician is trusting. In particular, if physician strategies are observable by patients, extremely strong gatekeeping preferences are required to make physicians mistrust. To limit unwarranted sicklisting, policies reducing the benefits of shirking for healthy workers may be better suited than attempts to convince physicians to be strict.
在给予工人带薪病假的社会保险制度中，医生充当把关人，据称只为病人而非逃避工作的人开具病假证明。先前的研究强调了医生在判断病人治疗需求以及相对于保险公司与病人潜在勾结方面的卓越能力。但人们对病人私人信息的作用了解较少。我们探讨了病人拥有不可验证症状存在的私人信息的情况。任何人都可以声称自己有此类症状，从而降低医生区分病人和逃避工作的人的能力。怀疑病人报告的症状可能会妨碍对真正病人的良好治疗。我们表明，对于所有参数值，贝叶斯纳什均衡是一些医生信任所有不可验证症状的说法，将逃避工作的人和病人都列入病假名单；对于许多值，每个医生都在信任。特别是，如果病人可以观察到医生的策略，则需要非常强烈的把关偏好才能使医生产生怀疑。为了限制无端的病假名单，减少健康工人逃避工作的好处的政策可能比试图说服医生严格执行的政策更适合。
