我国劝诱性医疗的成因:管制、市场结构还是信息不对称?

Physician Inducement in China's Medical Market:Regulation,Market Structure or Asymmetric Information?

本文使用一个价格管制背景下的医疗信号博弈模型讨论了我国劝诱性医疗现象的成因,以及管制、市场结构和信息不对称在导致资源配置扭曲中的作用机制和相互关系。研究表明,在无管制市场中,医生存在以价格承诺实现医疗资源最优配置的动机和可能。在政府对各项医疗收费实施全面价格管制的制度背景下,过低的诊断价格上限将使市场自发的事前价格承诺机制失灵,并诱发欺骗性的诊断结果,而药品和医疗器械使用的价格上限管制则诱使医生以增加药品和医疗器械使用量的数量决策来维持自身的垄断抽租能力。这两种机制的共同作用最终导致了双重劝诱性医疗均衡。在此均衡下,由于公立医院的垄断地位未受影响,故价格管制无法改善患者的福利状况,反而会导致社会的净福利损失。

This Paper explains Physician Inducement in China＇ s medical market with a signaling game under price ceilings, and discusses effects of regulation, market structure and asymmetric information on the allocation of medical resources. The analysis shows that,in a market without regulations,the doctor is willing to behave honestly with the commitment of price setting. Price ceilings will ruin the mechanism of price commitment and weaken hospital＇ s capability of obtaining monopolistic profit through pricing. Therefore, a comprehensive price control system will lead to both overtreatment caused by doctor＇ s misleading diagnosis and that derived from doctor＇ s attempting of transferring consumer surplus with quantity decisions. Due to hospital＇ s market power,price ceilings in China＇ s medical market have not improved consumers＇ welfare,but led to more deadweight loss.