多任务视角下质量监测对公立医院医疗服务质量的影响

Performance Rating, Multitasking and Quality of Medical Service Provision

本文在一个多任务委托代理的框架下,考察了对重点病种的监测如何扭曲公立医院的医疗服务供给行为。由于监管机构没有能力监督所有医疗服务的质量,仅仅选取典型的医疗服务进行监督,"理性"的医疗机构因为掌握一定的私人信息,能够采取监督机构无法观测到的行动,导致监督效果被扭曲。其结果,公立医院会在重点监测病种上过度投入,而在非监测病种上投入不足。我们基于成都市医保数据以及病案首页数据,验证了以上理论推断。实证结果表明:重点监测病种的患者比非监测病种的患者再入院率或死亡率显著更高;与民营医院相比,面临质量考核压力的公立医院在重点监测病种的治疗方面,以再入院率或死亡率衡量的医疗服务质量指标表现更好。

Under a multi-task principal-agent framework,this paper examines how surveillance of key diseases distorts the provision of medical services in public hospitals.Since regulators cannot monitor all medical services,but can only select representatives,the effectiveness of surveillance is distorted by rational medical institutions that have access to private information or are able to take unobservable actions.As a result,public hospitals are overreacting on priority diseases and underreacting on common ones.Based on the data of medical insurance and first-page medical records,we verifiy the above theoretical analysis.The empirical results show that patients with diseases subject to intensive surveillance have significantly lower rates of readmission or mortality than patients with common diseases.Compared with private hospitals,public hospitals under the pressure of quality assessment perform better on the quality of medical service,as measured by readmission rate or mortality rate,with regard to the diseases under key monitoring.