医疗市场管制：信息不对称、激励机制与社会福利

发布时间：2018-05-24 03:29

本文选题：医疗市场 + 非对称信息　；参考：《武汉大学》2014年博士论文

【摘要】：随着我国医疗改革的逐渐展开,医疗资源变得越来越丰富。但是“看病贵、看病难”的问题并没有得到有效的解决,反而有恶化的趋势。尽管城市里的大医院越来越多,规模也越来越大,但是患者到大医院就诊时需要等待的时间却越来越长。这一方面是由于人们更关注自身的健康问题,因此对医疗服务的需求增加,另一方面也是由于医疗市场的体制存在问题。本文主要讨论医疗市场上的信息问题对医患关系、医生行为以及医疗市场的影响。本文的第一章是绪论部分。第二章主要是对非对称信息以及激励理论的一个综述,简要回顾了非对称信息理论的基本分析框架。第三章则是对医疗市场上的非对称信息问题的理论概览和现状描述,研究了医疗市场上不对称信息的几种不同的形式、非对称信息对医疗市场的影响、信息披露解决非对称信息问题的效果以及我国医疗改革进程中的激励机制演变。第四章到第七章从不同的角度阐述非对称信息对医生行为以及医疗质量的影响。第四章分析不完全信息下的市场需求及其对医疗市场竞争的影响。患者需要依据医院的质量来选择合适的医院,但是他们能够获得的关于医院服务质量的信息是不确切的,因此即使是质量较低的医院也不会失去全部患者。这种不对称信息下的医疗市场结构会影响医院之间的质量竞争。结论是,只有当医院之间的服务质量相差不大时,医院才有改进质量的动力；而且,在通过医疗市场改革使得信息获取变得容易时,医院改进质量的倾向会变得更强。为了改善非对称信息带来的不利影响,医疗市场上的供给方会设计各种制度来解决问题。第五章分析了医院将规模作为信号发送机制导致的不均衡供求关系。产生这个问题的原因一方面是患者对自身的疾病状况不了解,另一方面则是患者的风险规避倾向。两方面的原因使得患大病的患者不愿意选择低水平医院,而患小病的患者则愿意选择高水平医院。当医院的大规模对患者而言意味着高水平时,大医院就会一直处于供不应求的状态。第六章分析了当医院把创新用作信号发送的机制是带来的问题。新的诊疗技术对患者而言往往意味着更高水平的诊疗水平,从而可以帮助医院吸引更多患者。但是,新技术并不一定意味着高水平的技术,而非对称信息环境下患者并不能了解药物的真实疗效。制药企业可以利用这种非对称信息进行无效创新(即实际上不能提高疗效的创新)来诱导患者购买新药,进而获取利润。对竞争市场而言,这种无效创新会带来过多的购买,带来市场的福利损失。第七章分析非对称信息下对医院(及医生)对人力资本投资与市场宣传投资的选择。之所以出现这种选择,是因为质量的改进需要花很长的时间才能被患者了解,进而为医院带来收入,而广告宣传投资则有助于更快地建立知名度。但是广告宣传带来的知名度需要高水平的诊疗质量来维持。因此,医院需要在短期收益和长期收益之间进行权衡。除此之外,“干中学”现象的存在使得医院有更强的倾向选择市场宣传投资,因为广告宣传投资可以使医院有临床实践机会,进而可以逐渐提高自身的诊疗水平。第八章对全文进行了总结与讨论。
[Abstract]:With the gradual expansion of medical reform in China, medical resources have become more and more rich. But the problem of "expensive medical care, difficult to see the doctor" has not been effectively solved, but it has a worsening trend. Although the large hospitals in the city are increasing, the scale is getting bigger and bigger, but the time for the patients to be waiting for the hospital is getting more and more This is because people pay more attention to their own health problems, so the demand for medical services increases, and the other is the problem of the medical market system. This paper mainly discusses the effects of information on medical market, doctor behavior and medical market.
The first chapter of this article is the introduction part. The second chapter is a summary of asymmetric information and incentive theory, and briefly reviews the basic analysis framework of asymmetric information theory. The third chapter is a theoretical overview and current situation description of asymmetric information in medical market, and studies several kinds of asymmetric information on medical market. Different forms, the impact of asymmetric information on the medical market, the effect of information disclosure to solve asymmetric information problems and the evolution of incentive mechanism in the process of medical reform in China.
From the fourth chapter to the seventh chapter, the influence of asymmetric information on doctors' behavior and medical quality is explained from different angles. The fourth chapter analyzes the market demand under incomplete information and its impact on the medical market competition. Patients need to choose the suitable hospital according to the quality of the hospital, but they can obtain the quality of hospital service. The information is not accurate, so even the lower quality hospital will not lose all the patients. The medical market structure under the asymmetric information will affect the quality of the hospital. The conclusion is that only when the quality of service between hospitals is small, the hospital has the power to change the quality; moreover, it is through the medical market. When reform makes information access easier, the tendency to improve the quality of hospitals will become stronger.
In order to improve the adverse effects of asymmetric information, the supply side in the medical market will design a variety of systems to solve the problem. The fifth chapter analyzes the disequilibrium supply and demand relationship caused by the hospital scale as a signaling mechanism. The reason for this problem is that the patient is not aware of the disease status of the patient, on the other hand, The patient's risk aversion. Two reasons make the patients suffering from a large illness reluctant to choose a lower level hospital, and the patients with a small illness are willing to choose a high level hospital. When the hospital's large scale means a high level to the patient, the large hospital will always be in a state of short supply.
The sixth chapter analyses the problems that the hospital brings about when it is used as a signal transmission mechanism. The new diagnostic techniques often mean a higher level of diagnosis and treatment for the patient, which can help the hospital attract more patients. However, the new technology does not necessarily mean a high level of technology, but the patient is not in the asymmetric information environment. Understand the real effects of drugs. Pharmaceutical companies can use this asymmetric information to make null innovation (i.e., actually not improve the effectiveness of innovation) to induce patients to buy new drugs, and then gain profits. For the competitive market, this invalidity innovation will bring too much purchase and bring the welfare loss of the market.
The seventh chapter analyzes the choice of investment and marketing of human capital and market for hospitals (and doctors) under asymmetric information. The reason for this choice is that the improvement of quality takes a long time to be understood by the patient, and then brings income to the hospital. In addition to the existence of the phenomenon of "secondary school", hospitals have a stronger tendency to choose market publicity investment, because the advertising propaganda can make the hospital have clinical practice opportunities, And you can gradually improve the level of diagnosis and treatment.
The eighth chapter is a summary and discussion of the full text.
【学位授予单位】：武汉大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R197.3

【参考文献】