Impact of Different Payment Methods on Physician Decision-Making Behavior Based on an Experimental Economics Approach

Wu Yuhan; Wumai'eraili Alimu; Hou Yanying; Lu Ruoyan

Abstract：Objective Exploring changes in physicians'healthcare delivery behaviors across medicare payment methods and when dealing with patients with different health statuses.Methods One hundred and ten medical students were recruited as subjects to simulate physicians making medical,behavioral decision scenarios through an experimental economics approach.Results The average number of medical services provided by subjects per patient was higher in fee-for-service(FFS)than in capitation payment(CAP);the situation of the number of services provided by subjects was better in mixed payment than in a single payment.The proportion of optimal decisions made by subjects for critically ill patients was the highest in the FFS system,whereas the difference in the number of optimal decisions made by subjects for mildly ill and critically ill patients in the CAP system was not statistically significant(P＞0.05);different payment methods,physician profits,and patient health status had an effect on the optimal decisions made by subjects.Conclusion In the FFS system,mildly ill patients are more over-treated,while moderately severe patients are more under-treated in the CAP system;hybrid payments can partly overcome the drawbacks of a single payment method and take advantage of a combination of advantages.There is altruistic heterogeneity in the behavior of subjects in the provision of health care,and interventions in physicians'decision-making behavior can be carried out by altering the external objective conditions and optimizing the endogenous factors.