公立醫院醫生防禦性醫療行為及其影響因素研究：基於廣東省某市公立醫院醫生問卷調查的實證研究

在衛生政策研究領域，中國醫療費用的急劇上升和由供方誘導的需求已是眾人皆知。然而，現有文獻大多傾向於將普遍存在的過度醫療行為歸因於醫院和醫生的逐利動機，但其實是由根植在中國醫療體系中扭曲的激勵機制所造成的。本研究於2013年12月對廣東省某市公立醫院504名執業醫師進行了問卷調查，發現過度醫療行為並不完全由經濟誘因支配；醫生防範醫患糾紛的防禦性醫療動機也在很大程度上導致了“大處方”和“過度檢查”的防禦性行為。回歸分析發現，低收入和對於付出和回報落差的不滿確實在很大程度上刺激了過度醫療行為。與此同時，醫生過往的醫患糾紛經歷亦顯著地影響其防禦性醫療行為。本研究揭示了當下緊張的醫患關係對於醫生行為的重要影響，並就此提出相應的政策建議。
The rapid cost escalation and vast supplier-induced demands in the Chinese health care system are well-known to the health policy research community. The existing literature tends to explain the pervasive overprovision of care by financial incentives of hospitals and physicians. Behind this is a series of misaligned perverse incentives embedded in the Chinese health system for decades. With a survey of public hospital physicians in a city of Guangdong, this study reveals that the overprovision of care, especially overprescription, is not solely driven by economic incentives, but also by physicians' motive of avoiding potential disputes with patients, reflecting defensive medical behaviors. The survey was conducted in December 2013, which selected 504 licensed physicians by random sampling. The regression analysis suggests that low income and the perceived imbalance between efforts and rewards indeed contribute to physicians' motivation of defensive medicine. In the meantime, their past experiences of medical disputes with patients are also found significantly associated with defensive behaviors. This study has revealed the critical impacts of the escalating tension between doctors and patients in distorting physician' behaviors, and lays out policy recommendations. Copyright © 2014 中國衞生政策研究编輯部.