Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Health Policy. 2021 Jan;125(1):98-103. doi: 10.1016/j.healthpol.2020.10.011. Epub 2020 Oct 24.
This paper uses survey data to analyse physician views on the risk of cream skimming under a system with activity based financing (ABF) for hospital services. We used data from two nation-wide physician surveys. A survey undertaken in 2006 captures views following a large NPM-inspired structural reform in 2002. In contrast, a survey undertaken in 2016 captures views after a period of a higher degree of institutional and financial stability. We find that the majority of physicians believed that the 2002 reform both provided incentives for and led to more cream skimming. In 2016, however there is less consensus among physicians about the extent of cream skimming. Looking at different types of physicians we find some indications that physicians in leading positions are less likely to view cream skimming as a problem. However, there is concern that hospital management in general puts too much emphasis on economic issues.
本文利用调查数据，分析了在按活动为基础的医院服务筹资制度（ABF）下，医生对“择肥而噬”风险的看法。我们使用了来自两次全国性医生调查的数据。2006 年进行的一次调查，反映了 2002 年受新公共管理理念影响的大规模结构性改革之后的看法。相比之下，2016 年进行的一次调查则反映了在一个更高程度的制度和财务稳定性时期的看法。我们发现，大多数医生认为，2002 年的改革既提供了激励，也导致了更多的“择肥而噬”。然而，2016 年，医生们对“择肥而噬”的程度的看法不再那么一致。我们考察了不同类型的医生，发现一些迹象表明，处于领导地位的医生不太可能认为“择肥而噬”是一个问题。然而，人们担心医院管理层普遍过于强调经济问题。
