Faculty of Economics and Business Administration & CINCH-Health Economics Research Center, University of Duisburg-Essen, 45127 Essen, Germany.
Int J Environ Res Public Health. 2020 Nov 10;17(22):8320. doi: 10.3390/ijerph17228320.
Recent policy reforms in Germany require the introduction of a performance pay component with bonus-malus incentives in the inpatient care sector. We conduct a controlled online experiment with real hospital physicians from public hospitals and medical students in Germany, in which we investigate the effects of introducing a performance pay component with bonus-malus incentives to a simplified version of the German Diagnosis Related Groups (DRG) system using a sequential design with stylized routine cases. In both parts, participants choose between the patient optimal and profit maximizing treatment option for the same eight stylized routine cases. We find that the introduction of bonus-malus incentives only statistically significantly increases hospital physicians' proportion of patient optimal choices for cases with high monetary baseline DRG incentives to choose the profit maximizing option. Medical students behave qualitatively similar. However, they are statistically significantly less patient oriented than real hospital physicians, and statistically significantly increase their patient optimal decisions with the introduction of bonus-malus incentives in all stylized routine cases. Overall, our results indicate that whether the introduction of a performance pay component with bonus-malus incentives to the (German) DRG system has a positive effect on the quality of care or not particularly depends on the monetary incentives implemented in the DRG system as well as the type of participants and their initial level of patient orientation.
德国最近的政策改革要求在住院医疗服务领域引入绩效薪酬部分，并辅以奖惩机制。我们在德国进行了一项针对公立医院医生和医学生的控制在线实验，使用简化版德国诊断相关分组（DRG）系统，采用顺序设计和典型常规病例，研究引入绩效薪酬部分和奖惩机制对系统的影响。在两个部分中，参与者都需要在相同的八个典型常规病例中，为患者选择最优治疗方案和利润最大化的治疗方案。我们发现，引入奖惩机制仅在具有高货币基线 DRG 激励以选择利润最大化方案的情况下，才会在统计学上显著增加医院医生选择患者最优方案的比例。医学生的表现类似，但他们的患者导向性明显低于医院医生，并且在引入奖惩机制后，他们在所有典型常规病例中都增加了患者最优决策的比例。总的来说，我们的结果表明，引入绩效薪酬部分和奖惩机制对（德国）DRG 系统的影响是否对护理质量产生积极影响，不仅取决于 DRG 系统中实施的货币激励措施，还取决于参与者的类型及其初始的患者导向性。
