医生人力资本、就医可及性与医疗服务错配——基于某省医院微观数据的实证研究

Physician Human Capital,Access to and Mismatch of Health Care

中国的多层次医学教育体系产生了巨大的医生人力资本异质性。本文试图利用医生人力资本水平的差异,结合我国某省的DRGs数据揭示医院医疗服务错配与医生人力资本、就医可及性之间的关系。研究发现:第一,人力资本水平越高的医院,其医疗服务错配程度越高;第二,医生人力资本与就医可及性存在互补效应,显著提高医疗服务错配程度,该结论在控制内生性和一系列稳健性检验后仍成立。第三,外科的错配效应比内科更显著,相对省属医院,错配效应在县市属医院更强。据此,本文认为患者的“用脚投票”就医行为和中国医生人力资本两级分化带来了大医院医疗服务的错配效应。

Higher level of physician human capital in hospitals significantly increases the mismatch of health care and accessibility to health care is complementary to physician human capital level,which significantly increases mismatch degree.Moreover,the mismatch degree of hospital health care is higher in internal medicine departments compared with that in surgeon departments,and the county-level and prefecture-level hospitals have greater mismatch of health care than provincial hospitals.The mismatch of health care in China is caused by both the patients' unprofessional choice and the heterogeneity and aggregation of physician human capital.