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首页> 外文期刊>Journal of health economics >The effect of financial incentives on gatekeeping doctors: Evidence from a natural experiment
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The effect of financial incentives on gatekeeping doctors: Evidence from a natural experiment

机译：经济激励措施对看门医生的影响：来自自然实验的证据

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In many health care systems generalist physicians act as gatekeepers to secondary care. Under the English fundholding scheme from 1991 /1992 to 1998/1999 general practices could elect to be given a budget to meet the costs of certain types of elective surgery (chargeable electives) for their patients and could retain any surplus. They did not pay for non-chargeable electives or for emergency admissions. Non-fundholding practices did not bear the cost of any type of hospital admissions. Fundholding is to be reintroduced from April 2005. We estimate the effect of fundholding using a differences in differences methodology on a large 4-year panel of English general practices before and after the abolition of fundholding. The abolition of fundholding increased ex-fundholders' admission rates for chargeable elective admissions by between 3.5 and 5.1%. The effect on the early wave fundholders was greater (around 8%) than on later wave fundholders. We also use differences in differences for two types of admissions (non-chargeable electives, emergencies) not covered by fundholding as additional controls for unobserved temporal factors. These differences in differences in differences estimates suggest that the abolition of fund-holding increased ex-fundholders' chargeable elective admissions by 4.9% (using the non-chargeables DID) and by 3.5% (using the emergencies DID).
机译：在许多医疗保健系统中，全科医生充当二级保健的看门人。根据1991/1992年至1998/1999年的英国资金持有计划，可以选择一般做法作为预算，以支付患者某些类型的择期手术（收费的择期手术）的费用，并可以保留任何盈余。他们没有为免费的选修课或紧急招生付费。非持股做法不承担任何类型的住院费用。从2005年4月起将重新引入资金持有方式。在取消资金持有方式之前和之后，我们使用差异差异方法对大型的4年英语通用惯例小组评估了资金持有方式的效果。取消持股，可收费的选择性招生的前基金持有人的招生率提高了3.5％至5.1％。对早期浪潮基金持有人的影响大于后期浪潮基金持有人的影响（约8％）。我们还将两种类型的录取差异（不收取费用的选修课，紧急情况）用差异进行差异化，这两种类型的入学率未被资金持有作为对未观察到的时间因素的额外控制。这些差异估计中的差异表明，取消持股会增加前基金持有人的应课税选修录取率（使用非应收账款DID）增加4.9％，使用紧急情况DID则增加3.5％。

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