Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, China.
Front Public Health. 2024 May 2;12:1323090. doi: 10.3389/fpubh.2024.1323090. eCollection 2024.
It introduced an artefactual field experiment to analyze the influence of incentives from fee-for-service (FFS) and diagnosis-intervention package (DIP) payments on physicians' provision of medical services.
This study recruited 32 physicians from a national pilot city in China and utilized an artefactual field experiment to examine medical services provided to patients with different health status.
In general, the average quantities of medical services provided by physicians under the FFS payment were higher than the optimal quantities, the difference was statistically significant. While the average quantities of medical services provided by physicians under the DIP payment were very close to the optimal quantities, the difference was not statistically significant. Physicians provided 24.49, 14.31 and 5.68% more medical services to patients with good, moderate and bad health status under the FFS payment than under the DIP payment. Patients with good, moderate and bad health status experienced corresponding losses of 5.70, 8.10 and 9.42% in benefits respectively under the DIP payment, the corresponding reductions in profits for physicians were 10.85, 20.85 and 35.51%.
It found patients are overserved under the FFS payment, but patients in bad health status can receive more adequate treatment. Physicians' provision behavior can be regulated to a certain extent under the DIP payment and the DIP payment is suitable for the treatment of patients in relatively good health status. Doctors sometimes have violations under DIP payment, such as inadequate service and so on. Therefore, it is necessary to innovate the supervision of physicians' provision behavior under the DIP payment. It showed both medical insurance payment systems and patients with difference health status can influence physicians' provision behavior.
本研究采用准实验方法，分析按项目付费（FFS）和诊断相关分组（DIP）支付方式下的激励对医生医疗服务供给的影响。
本研究从全国医保支付方式改革试点城市招募了 32 名医生，采用准实验方法，考察了不同健康状况患者的医疗服务供给情况。
总体而言，FFS 支付下医生提供的医疗服务量高于最优量，差异具有统计学意义；DIP 支付下医生提供的医疗服务量非常接近最优量，差异无统计学意义。FFS 支付下，医生为健康状况良好、中等和较差的患者提供的医疗服务分别比 DIP 支付下多 24.49%、14.31%和 5.68%。健康状况良好、中等和较差的患者在 DIP 支付下分别损失了 5.70%、8.10%和 9.42%的利益，相应的医生收益减少了 10.85%、20.85%和 35.51%。
FFS 支付下患者过度服务，但健康状况较差的患者可以得到更充分的治疗。DIP 支付可以在一定程度上规范医生的供给行为，DIP 支付适合治疗健康状况较好的患者。医生在 DIP 支付下有时会出现服务不足等违规行为，因此需要创新 DIP 支付下医生供给行为的监管。研究结果表明，医疗保险支付方式和患者的健康状况都会影响医生的供给行为。
