“退出”、“呼吁”与医生行为的激励机制

中国公立医院现行的医生激励机制难以有效激励医生合理医疗。依据赫希曼(Hirschman)的"退出-呼吁"理论,文章首次构建博弈模型分析患者呼吁在约束医生行为方面的作用,并分析了患者退出对医生行为的影响。当二者成本较低时,患者退出和呼吁能够约束医生合理医疗。但随着患者退出和呼吁成本的提高,上述机制作用下降,直至完全无效。此外,患者退出有利于正面激励医生。文章围绕降低患者的退出和呼吁成本,从外部治理和内部治理入手,重构医生激励机制。

Exit, Voice and the Incentive Mechanism of Doctors

There are shortcomings with the public hospital existing incentive mechanism of doctors,which can not encourage doctors to behave properly.According to Hirschman’s "exit - voice"theory,we construct game theory model to analyze voice effect on doctors’ behavior.We also research exit effect on doctors’ incentive.In certain circumstances with low exit and voice cost,patients’ exit and voice can be helped to bind doctors’ behavior and control doctors’ deceit preference. As the cost of patients’ exit or voice ascends,patients’ willing to exit or voice descends.So does the effect of patients’ exit and voice,until there is zero effect.We also believe that reasonably prompting patients’ exit is useful in encouraging doctors to behave properly.The suggestion is keeping the cost of exit and voice low by reconstruction of doctors incentive - restraining mechanism and coordination of external govern and inner management.