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提供者更倾向于提高患者的健康效益与更高的医疗质量相关。

Providers preferences towards greater patient health benefit is associated with higher quality of care.

机构信息

Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, MD, 21205, USA.

Population Services International Myanmar, No. 16, West Shwe Gone Dine 4th Street, Yangon, Myanmar.

出版信息

Int J Health Econ Manag. 2021 Sep;21(3):271-294. doi: 10.1007/s10754-021-09298-2. Epub 2021 Jun 4.

Abstract

Standard theories of health provider behavior suggest that providers are motivated by both profit and an altruistic interest in patient health benefit. Detailed empirical data are seldom available to measure relative preferences between profit and patient health outcomes. Furthermore, it is difficult to empirically assess how these relative preferences affect quality of care. This study uses a unique dataset from rural Myanmar to assess heterogeneous preferences toward treatment efficacy relative to provider profit and the impact of these preferences on the quality of provider diagnosis and treatment. Using conjoint survey data from 187 providers, we estimated the marginal utilities of higher treatment efficacy and of higher profit, and the marginal rate of substitution between these outcomes. We also measured the quality of diagnosis and treatment for malaria among these providers using a previously validated observed patient simulation. There is substantial heterogeneity in providers' utility from treatment efficacy versus utility from higher profits. Higher marginal utility from treatment efficacy is positively associated with the quality of treatment among providers, and higher marginal utility from profit are negatively associated with quality of diagnosis. We found no consistent effect of the ratio of marginal utility of efficacy vs marginal utility of profit on quality of care. Our findings suggest that providers vary in their preferences towards profit and treatment efficacy, with those providers that place greater weight on treatment efficacy providing higher quality of care.

摘要

标准的医疗服务提供者行为理论认为,提供者的动机既包括利润,也包括对患者健康利益的利他主义兴趣。很少有详细的经验数据来衡量利润和患者健康结果之间的相对偏好。此外,很难从经验上评估这些相对偏好如何影响医疗质量。本研究利用缅甸农村地区的独特数据集,评估了相对于提供者利润的治疗效果的异质偏好,以及这些偏好对提供者诊断和治疗质量的影响。我们使用来自 187 名提供者的联合调查数据,估计了更高治疗效果和更高利润的边际效用,以及这些结果之间的边际替代率。我们还使用以前验证过的观察到的患者模拟来衡量这些提供者的疟疾诊断和治疗质量。提供者从治疗效果中获得的效用与从更高利润中获得的效用之间存在很大的异质性。更高的治疗效果边际效用与提供者的治疗质量呈正相关,而更高的利润边际效用与诊断质量呈负相关。我们没有发现治疗效果的边际效用与利润的边际效用之比对护理质量的一致影响。我们的研究结果表明,提供者在利润和治疗效果方面的偏好存在差异,那些更重视治疗效果的提供者提供更高质量的护理。

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