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混合薪酬制度下专科医生的医疗质量：实证分析

Healthcare Quality by Specialists Under a Mixed Compensation System: An Empirical Analysis.

作者信息

Echevin Damien, Fortin Bernard, Houndetoungan Aristide

机构信息

CRCHUS, and Université de Sherbrooke, Sherbrooke, Québec, Canada.

Université Laval, CIRANO, and CRREP, Québec, Québec, Canada.

出版信息

Health Econ. 2025 May;34(5):972-991. doi: 10.1002/hec.4943. Epub 2025 Mar 3.

DOI:10.1002/hec.4943
PMID:40033422
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11961350/
Abstract

We analyze the effects of a mixed compensation (MC) scheme for specialists on the quality of their healthcare services. We exploit a reform implemented in Quebec (Canada) in 1999. The government introduced a payment mechanism combining a per diem with a reduced fee per clinical service. Using a large patient/physician panel dataset, we estimate a multi-state multi-spell hazard model analogous to a difference-in-differences approach. We compute quality indicators from our model. Our results suggest that the reform reduced the quality of MC specialist services measured by the risk of rehospitalization and mortality after discharge.

摘要

我们分析了针对专科医生的混合薪酬（MC）方案对其医疗服务质量的影响。我们利用了1999年在加拿大魁北克实施的一项改革。政府引入了一种支付机制，将每日津贴与每项临床服务降低的费用相结合。使用一个大型患者/医生面板数据集，我们估计了一个类似于差分法的多状态多轮次风险模型。我们从模型中计算质量指标。我们的结果表明，这项改革降低了以出院后再次住院风险和死亡率衡量的MC专科医生服务质量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b3b4/11961350/42676b462b31/HEC-34-972-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b3b4/11961350/4c5047798ed0/HEC-34-972-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b3b4/11961350/8089231293e8/HEC-34-972-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b3b4/11961350/61e8df9094c5/HEC-34-972-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b3b4/11961350/3835fa2a93f9/HEC-34-972-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b3b4/11961350/42676b462b31/HEC-34-972-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b3b4/11961350/4c5047798ed0/HEC-34-972-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b3b4/11961350/8089231293e8/HEC-34-972-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b3b4/11961350/61e8df9094c5/HEC-34-972-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b3b4/11961350/3835fa2a93f9/HEC-34-972-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b3b4/11961350/42676b462b31/HEC-34-972-g005.jpg

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本文引用的文献

1
Physician altruism under the change from pure payment system to mixed payment schemes: experimental evidence.从纯支付制度向混合支付方案转变下的医师利他主义：实验证据。
BMC Health Serv Res. 2023 Feb 2;23(1):111. doi: 10.1186/s12913-023-09112-4.
2
Effects of fee-for-service, diagnosis-related-group, and mixed payment systems on physicians' medical service behavior: experimental evidence.按服务项目付费、按诊断相关分组付费和混合付费制度对医生医疗服务行为的影响：实验证据。
BMC Health Serv Res. 2022 Jul 5;22(1):870. doi: 10.1186/s12913-022-08218-5.
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Costs and Consequences of Early Hospital Discharge After Major Inpatient Surgery in Older Adults.
老年人重大住院手术后早期出院的成本与后果
JAMA Surg. 2017 May 17;152(5):e170123. doi: 10.1001/jamasurg.2017.0123.
4
The Effects of Introducing Mixed Payment Systems for Physicians: Experimental Evidence.引入医生混合支付系统的效果：实验证据
Health Econ. 2017 Feb;26(2):243-262. doi: 10.1002/hec.3292. Epub 2015 Dec 28.
5
Is the readmission rate a valid quality indicator? A review of the evidence.再入院率是一个有效的质量指标吗？证据综述。
PLoS One. 2014 Nov 7;9(11):e112282. doi: 10.1371/journal.pone.0112282. eCollection 2014.
6
Do Physicians' Financial Incentives Affect Medical Treatment and Patient Health?医生的经济激励是否会影响医疗和患者健康？
Am Econ Rev. 2014 Apr;104(4):1320-1349. doi: 10.1257/aer.104.4.1320.
7
Measuring the hospital length of stay/readmission cost trade-off under a bundled payment mechanism.在捆绑支付机制下衡量住院时间/再入院成本的权衡
Health Econ. 2015 Jul;24(7):790-802. doi: 10.1002/hec.3061. Epub 2014 May 7.
8
Physician payment mechanisms, hospital length of stay and risk of readmission: evidence from a natural experiment.医生支付机制、住院时间和再入院风险：来自一项自然实验的证据。
J Health Econ. 2014 Jul;36:112-24. doi: 10.1016/j.jhealeco.2014.03.008. Epub 2014 Apr 12.
9
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J Health Econ. 2008 Dec;27(6):1436-50. doi: 10.1016/j.jhealeco.2008.07.010. Epub 2008 Jul 30.
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Do hospital length of stay and staffing ratio affect elderly patients' risk of readmission? A nation-wide study of Norwegian hospitals.住院时间和人员配备比例会影响老年患者再次入院的风险吗？一项对挪威医院的全国性研究。
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