中性框架与医疗决策框架下博弈实验测量医生利他性的比较研究

A comparative study of game experiments measuring physicians' altruism under neutral and medical decision-making frameworks

目的:比较两种框架下利用博弈实验测量医生利他性的异同,为利他性测量方法选择和量化分析提供参考依据。方法:分别运用中性框架与医疗决策框架博弈实验两种方式测度个体利他性,招募162名医学生在两种框架下进行决策。中性框架下基于社会偏好模型计算利他参数,医疗决策框架下包含竞争和不竞争实验场景,基于随机效用模型与固定效应模型计算利他参数。结果:受试者利他性存在一定异质性。中性框架下40%的受试者利他参数大于0.5;医疗决策框架下混合logit模型与条件logit模型利他参数(边际替代率)估计结果具有一致性,不竞争(竞争)场景下48.6%(94.5%)医生利他参数大于1,说明受试医学生相对于个人(医生)利润更重视他人(患者)效益。中性框架和医疗决策框架下不竞争场景测度利他参数显著正相关(Spearman’s ρ=0.2917,P<0.001)。结论:两种框架下测量的医学生均有较高的利他性,中性框架医生利他性相对稳定,医疗决策框架下实验场景的变化显著影响利他参数的数值。

Objective:To compare the similarities and differences between two frameworks for calculating physicians' altruism in game experiments,and to provide a reference for the selection of altruistic measurement and quantitative analysis.Methods:The neutral framework and the medical decision-making framework game experiment were used to measure individual altruism,and 162 medical students were recruited to make decisions under the two frameworks.Altruistic parameter was calculated based on social preference model under the neutral framework,and competition and non-competition experimental scenarios are included in the medical decision-making framework,and altruistic parameters are calculated based on stochastic utility model and fixed-effect model.Results:There was heterogeneity in subjects' altruism.40% of subjects' altruism under the neutral framework was greater than 0.5.The estimation results of the altruistic parameters(marginal substitution rate) of the mix logit model and the conditional logit model in the medical decision-making framework were consistent,48.6%(94.5%) of physicians' altruism in the non-competitive(competitive) scenario was greater than 1,representing that the tested medical students valued the benefits of others(patients') more than personal(physicians') profits.The altruistic parameter calculated by the neutral framework is significantly and positively correlated with the MRS in the non-competitive scenario calculated in the decision-making framework(Spearman's ρ=0.2917,P<0.001).Conclusion:Medical students measured under both frameworks demonstrated high altruism,the altruism in neutral framework was relatively stable,and variations in the experimental scenarios under the medical decision-making framework affected the values of the altruistic parameter significantly.