Tai-Seale M, Rice T H, Stearns S C
School of Public and Environmental Affairs, Indiana University, Bloomington 47405, USA.
Health Econ. 1998 May;7(3):199-219. doi: 10.1002/(sici)1099-1050(199805)7:3<199::aid-hec344>3.0.co;2-n.
The effects of changing financial incentives on physician's practice behaviour have long been of interest to researchers and policy makers. We test a model of physician volume response within the context of multiple payers developed by Thomas McGuire and Mark Pauly. A panel data set covering discharges from about 200 hospitals in the US over 45 months is used to carry out the empirical investigation. A fixed-effect model with generalized least squares and instrumental variable specifications is used to compute empirical evidence of volume responses from eight specialties experiencing varying degrees of Medicare payment reductions following the implementation of Omnibus Budget Reconciliation Acts of 1989 and 1990. The empirical findings are compared with McGuire and Pauly's simulated predictions. We note that in examining physician responses to Medicare payment reductions in the context of a multi-payer environment, it becomes evident that only fixing one payer's reimbursement policy is at best a partial solution to cost containment. We echo observations made by other analysts that physician responses to payment changes can be quite complex. Physicians do not all respond to payment reduction in the same way.
改变经济激励措施对医生执业行为的影响长期以来一直是研究人员和政策制定者感兴趣的问题。我们在托马斯·麦圭尔和马克·保利所构建的多支付方背景下，对医生诊疗量反应模型进行了检验。使用一个涵盖美国约200家医院45个月出院情况的面板数据集来开展实证研究。采用具有广义最小二乘法和工具变量设定的固定效应模型，以计算1989年和1990年《综合预算调节法案》实施后，八个经历了不同程度医疗保险支付削减的专科的诊疗量反应的实证证据。将实证结果与麦圭尔和保利的模拟预测进行比较。我们注意到，在多支付方环境中考察医生对医疗保险支付削减的反应时，很明显，仅固定一个支付方的报销政策充其量只是控制成本的部分解决方案。我们赞同其他分析人士的观点，即医生对支付变化的反应可能相当复杂。医生并非都以相同方式对支付削减做出反应。
