支付机制与全科医生自我选择:收费与服务收费。

Marie Allard, Izabela Jelovac, Pierre-Thomas Léger
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引用次数: 17

摘要

本文分析了允许把关全科医生(全科医生)选择他们的支付机制的后果。我们模拟了全科医生在最常见的付费方案(收费和服务费)下的行为,以及全科医生可以在其中选择一种的情况。我们的分析考虑了全科医生在能力和对病人健康的关注方面的异质性。我们表明,当浪费转诊到昂贵的专科护理的成本相对较高时,服务费用支付是最优的,以最大限度地提高患者的预期健康净治疗成本。相反,当与转诊失败的重症患者相关的损失相对较高时,我们表明,全科医生自行选择支付形式或资本化是最优的。最后,我们将分析扩展到内生努力和gp之间的竞争。在这两种情况下,我们都表明自我选择从来都不是最优的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Payment mechanism and GP self-selection: capitation versus fee for service.

This paper analyzes the consequences of allowing gatekeeping general practitioners (GPs) to select their payment mechanism. We model GPs' behavior under the most common payment schemes (capitation and fee for service) and when GPs can select one among them. Our analysis considers GP heterogeneity in terms of both ability and concern for their patients' health. We show that when the costs of wasteful referrals to costly specialized care are relatively high, fee for service payments are optimal to maximize the expected patients' health net of treatment costs. Conversely, when the losses associated with failed referrals of severely ill patients are relatively high, we show that either GPs' self-selection of a payment form or capitation is optimal. Last, we extend our analysis to endogenous effort and to competition among GPs. In both cases, we show that self-selection is never optimal.

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