医院价格与质量信息披露对医疗服务市场供需双方行为的影响——基于国际文献的叙事综述

The Impact of Hospital Price and Quality Transparency on the Supply and Demand Sides of Healthcare Market:A Narrative Review

医疗服务价格与质量信息披露是缓解供需双方信息不对称、提高医疗市场运行效率的重要政策工具,近年来备受关注的医院排名就是其应用形式之一。基于发表在健康经济与健康政策领域国际期刊上的实证研究,本文通过叙事综述的方法研究了医院价格与质量信息披露政策对患者就医选择与医院市场份额、医院服务质量与医院策略性行为的影响。研究发现,医院价格与质量信息披露并未如理论预期一般改善了患者就医选择,也因此未能显著影响医院市场份额;医院质量信息披露虽然改善了医院的质量评价指标,但并未带来患者健康结局的对等提升,还引致了医院的策略性行为;政府管制、市场竞争与声誉约束是医院质量信息披露得以影响医疗服务质量的三大机制,在医疗服务领域,关乎职业声誉的内在激励可能比影响财务收入的经济激励更加重要。

Healthcare service's price and quality transparency is an essential way to alleviate information asymmetry between providers and consumers,which is critical to improve the efficiency of healthcare market.As one of its application forms,hospital ranking program has attracted much attention in recent years.Based on evidence from the main-stream English journals in Health Economics and Health Policy,this study conducted a narrative review to investigate the impact of hospital price and quality transparency on(1)consumer's healthcare choices and hospital's market shares,and(2)healthcare quality and hospital's strategic behavior.This study found that hospital price and quality transparency did not improve patients'choice as theory expected,and therefore failed to significantly change hospital market shares.Hospital quality transparency policy improved hospital's performance on some specific quality indicators targeted by ranking and rating schemes.However,it did not significantly improve patients'health outcomes and,alternatively,fostered hospital's strategic behavior.Regulation,competition and reputation are three main channels through which hospital quality transparency could affect care quality.In healthcare sector,non-financial and intrinsic incentives might be more important than financial and extrinsic incentives.