家庭医生签约背景下竞争机制引入对医生行为影响的实验研究

Objectives: To investigate the effects of the “dual mechanism” of payment systems and competition on doctors’ behavior under the background of family doctor contract, and to provide experimental economics evidence for the improvement of the family doctor contract system. Methods: A controlled laboratory experiment was conducted in the design of non-competitive and competitive scenarios combining with two payment systems, capitation (CAP) and fee-for-service (FFS). We recruited 162 medical students as subjects to provide the medical treatment for the patients with different severities. The random effects model was used to analyze the effect of competition mechanisms on the doctors’ medical treatment and patients’ health benefit; Fisher’s combination test was used to explore the differences in the impact of introducing competition mechanism to different payment systems on doctors’ behavior. Results: Introducing competition mechanism can reduce under-provision under CAP and overprovision under FFS respectively. For patients in poor (good) health condition, the competition mechanism changed doctors’ behavior more apparently under CAP (FFS). The comparison of the intergroup coefficients for the competition mechanism showed that, compared with “FFS + competition”, the loss of patients’ health benefit was less under “CAP + competition” mechanism. Compared with no-competition to competition scenario, the deviation from patient optimal treatment increased in the competition to no-competition scenario. Conclusion: The treatment quality of family doctors is improved by introducing competition mechanism, the dual mechanism design of CAP combined with competition is more advantageous.