| BackgroundPrivate clinics play an important role in China’s medical and health system.In 2014,the number of private clinics in China has reached 1491 75,accounting for more than 96%of the total number of clinics in China.The main reason why private clinics are accepted by the masses is that such clinics have good accessibility,patients can get medical treatment conveniently and the cost is low.However,due to the fact that private clinics are not included in his and other medical IT systems,the diagnosis and treatment behavior of physicians in private clinics and the management of private clinics have been on the edge of health management research.The prescription behavior of physicians directly determines the quality of medical services,so it is a very important part of medical services.The health service market of private clinics in China is different from that of public hospitals,which can hardly be included in medical insurance reimbursement.Due to the influence of payment methods,medical service scope and physicians’ professional level,unreasonable prescriptions of physicians are very commonCommon cold is one of the common diseases of the people.Although the incidence rate of the disease is high and there is no specific medicine at present,the common cold is a self limited disease,usually it can heal itself within 7 days.At present,there are many problems in the treatment of common cold in primary medical institutions The main problems are nonstandard diagnosis and treatment process,nonstandard use of antibiotics,irrational use of Chinese patent medicines,etcIn recent years,the relevant management departments have paid attention to the introduction of various policies,regulations and regulatory measures to strictly manage the diagnosis and treatment activities of private clinics,hoping to effectively improve the quality of medical services in private clinics.However.due to the lack of specific regulatory measures and means in private clinics,it is difficult to manage private clinics like public medical institutions.Therefore,it is helpful for the government to optimize the corresponding health policies and improve the quality of medical services in private clinics by analyzing the diagnosis and treatment behaviors of physicians in private clinics and exploring the factors influencing physicians’prescription behaviors.There are two characteristics of medical service demand,one is uncertainty,the other is information asymmetry,so it is necessary to establish a specific principal-agent relationship between the demand side(patients)and the demand side(physicians).which is the unique characteristics of the medical service market.The harm of information asymmetry is "moral damage" and induced demand in the market.Economists have found that the hypothesis of "rational man" in neoclassical economics can not explain all the phenomena in real economic society,especially the behaviors of physicians,which needs new theories to explain.Behavioral economists put forward the physician altruism model.and think that the utility of physicians comes from three aspects,namely,net income,leisure time and the induction of ineffective use of patients,but there is little empirical evidence in this respect.After analyzing the related literature of previous studies,we found that due to the measurement difficulty of altruism and the difficulty of field experiment is far greater than that of laboratory experiment,the research on the relationship between altruism and physician’s diagnosis and treatment behavior is still less:(1)the research on physician’s altruism is mainly carried out from the theoretical research,and lacks the data support of empirical research;(2)the research on altruism is mainly from the perspective of theory.At present.few studies focus on the relationship between physicians’ Altruism and prescription behavior and other medical behaviors,and whether physicians’ social preferences are consistent;(3)physicians’ social altruism is only differentiated from altruism and non altruism,which is not detailed enough.ObjectivesThe overall objective of this study:using the method of field experiment,anonymous audit was used to test the diagnosis and treatment behavior of private clinic physicians,find out the problems in the process of diagnosis and treatment of common cold,analyze the altruistic level of physicians under social norms,the level of altruism in medical situation,gender and physician prescription behavior relationship,and explore the physician’s social It also puts forward suggestions to improve the existing supervision measures of medical behavior in private clinics,so as to promote the overall health level.The specific objectives of this study are as follows:(1)through the anonymous audit experiment on the behavior of private clinic physicians in the process of diagnosis and treatment of common cold,the specific diagnosis and treatment behavior of physicians is quantified and evaluated,and the existing problems are found,so as to provide decision-making basis for health policy makers and decision-makers to optimize and formulate relevant regulatory policies and optimize regulatory means.(2)Objective to analyze the differences of diagnosis and treatment behaviors of different genders in private clinics,and explore the relationship between gender and physicians’ behaviors.(3)Through the altruism experiment based on social norms to evaluate physicians’altruism,combined with the physicians’ Altruism level in medical situation,the relationship between physicians’ Altruism level under social norms and medical situation was analyzed.Research design and methodsThe subjects of this study are private clinics and medical practitioners in Qingdao,From the official website of Qingdao health and Family Planning Commission,133 clinics were randomly selected as the research objects.Through the method of random pairing in econometrics,the problem of private information protection in the experimental process is guaranteed.Experimental design(1):anonymous audit of physician’s medical service behavior.In this study.36 female college students(17 groups+2 backup)were recruited as auditors.Before the formal experiment,standardized training and pre experiment were conducted for auditors and other staff to ensure that the auditor’s statement of common cold symptoms was more strictly in accordance with the proposed lines,and the communication process with physicians was consistent,so as to avoid the endogenous problem of gender compatibility of physicians and patients,which would affect the experimental results.In the experiment,the auditor pretended to be a patient,went to the clinic to report his symptoms(the same as the common cold),recorded the process of medical service provided by the physician,and filled in the "patient assessment questionnaire" after leaving the clinic.Experiment design(2):To observe the altruism of physicians through altruism experiment.In this study,the investigator played the role of a common cold patient to a private clinic.At the end of the visit,the wallet with the information of "owner" and other items was quietly put into the clinic.We judge the degree of altruism of physicians according to whether they contact with the "owner" and how to deal with the cash in the wallet,and divide them into strong altruistic group,weak altruistic group and non altruistic group in terms of social norms.At the same time,compared with the behavior of physicians in experiment(1),the differences of physicians’ behavior among the three groups were analyzed.At the same time,this study also analyzed the relationship between physicians’ gender and prescription behavior.In this study.SPSS 22.0(Chinese version)software and Microsoft Office Excel 2007 software were used for data entry and statistical analysis.For continuous dependent variables,ANOVA and general linear regression model were used for analysis.Chi square test was used for the dependent variables of classification variable types,and logistic regression model was established for analysis.Results(1)Problems in clinic diagnosis and treatment serviceWhen doctors in private clinics treat common cold.there is a phenomenon of nonstandard diagnosis and treatment and nonstandard medication.For example,in the course of consultation,less than 50%of doctors asked whether patients cough or expectoration.less than 20%of doctors used stethoscope,and less than 30%of doctors asked whether patients were allergic to drugs.Although patients do not need to take any drugs,the proportion of doctors who prescribe drugs is very high.Among them,88.72%of doctors prescribe drugs,48.87%prescribe antibiotics,72.93%prescribe Chinese patent medicine,64.66%prescribe western medicine,and 70.68%prescribe two or more drugs for patients.The proportion of doctors who prescribe drugs is high,but the proportion of doctors who provide pharmaceutical services is not high.For example,64.66%of doctors inform patients of medication methods,only 9.02%of doctors inform patients of side effects of drugs,and 78.95%of doctors inform patients of other precautions.There are a large number of irrational use of antibiotics in clinics.48.87%(65/133)of physicians prescribed antibiotics for patients,and the average number of antibiotics prescribed by each physician was 0.49± 0.91.The antibiotics prescribed by physicians were divided into four categories.Cephalosporins accounted for 56.92%(37/65),macrolides accounted for 16.92%(11/65).penicillins accounted for 13.85%(9/65).quinolones accounted for 12.31%(8/65).No physician prescribed two or more antibiotics for patients.In this study,one physician prescribed ribavirin for "patients",accounting for 0.75%(I/133)of the total number of physicians.In this study,97 physicians prescribed Chinese patent medicine for patients,accounting for 72.93%(97/133)of the total number of physicians.In this study,all physicians are western medicine.When prescribing Chinese patent medicines for cold,they can not diagnose patients by "looking.smelling,listening and cutting",so they can’t use drugs dialectically.At the same time.patients did not mention cardiovascular or orthopedic discomfort,but some physicians prescribed Chinese patent medicine for cardio cerebral system and orthopedic Chinese patent medicine for patients,which was obviously beyond the scope of medication.However,88.72%(118/133)of physicians prescribed drugs for "patients",with an average of 1.80± 0.92 kinds of prescriptions per physician,and the average price of each physician was 38.35±25.19 yuan.(2)Altruism and prescription behavior of physiciansIn the altruism experiment under social norms(”lost wallet"),physicians show different altruism level.Of the 133 sample clinics,66 called back to ask if anyone had lost their wallets and sent them back at the request of the experimenters.One clinic called back,but asked the "owner" to pick up the wallet.Altruism can be divided into ego altruism and pure altruism.Ego-altruism refers to the individual’s concern for the interests of himself and others at the same time.Pure altruism refers to the fact that individuals only care about the interests of others.According to this definition,38 physicians who sent back their wallets and returned the remaining cash were regarded as the pure altruism group.28 physicians who sent back their wallets but did not return the cash,and 1 physician who asked the "owner" to collect the wallet were regarded as the ego-altruism group.and the physicians from 66 clinics were regarded as the egoism groupThe results showed that there were statistically significant differences in the total types of prescriptions,the types of antibiotics,the total price of drugs and the price of antibiotics among the pure altruism group,egoism group and ego-altruisim group.The details are as followsFor the item A2 prescribes antibiotics or not.the difference between pure altruism group,ego-altruism group and egoism group was statistically significant.The performance of pure altruism group was better than that of egoism group,and the performance of egoism group was due to ego-altruisim group.For the item B1 prescriptions,the difference between pure altruism group and ego-altruisim group was statistically significant(P<0.05).and the performance of pure altruism group w as better than that of ego-altruisim group;the difference between pure altruism group and egoism group was not statistically significant(P=0.492),but the difference between ego-altruisim group and ego-altruisim group was large,but not statistically significant(P=0.065)For the item B2 antibiotics.the difference between pure altruism group and ego-altruisim group was statistically significant(P<0.05).and the performance of pure altruism group was better than that of ego-altruisim group;the difference between pure altruism group and egoism group was significant(P=0.056).and the difference between ego-altruisim group and egoism group was statistically significant(P<0.05)For the total price of C1 drugs,the difference between pure altruism group and ego-altruisim group was statistically significant(P<0.05),and the performance of strong pure altruism group was better than that of ego-altruisim group;the difference between pure altruism group and egoism group was not statistically significant(P=0.686).but the difference between ego-altruisim group and ego-altruisim group was larger but not statistically significant(P=0.053).For the itemC2 antibiotic drug prices,the difference between pure altruism group and ego-altruisim group was statistically significant(P<0.05),and the performance of pure altruism group was better than that of ego-altruisim group;the difference between pure altruism group and egoism group was not statistically significant(P=0.164),and the difference between ego-altruism group and ego-altruism group was statistically significant(P<0.05)(3)Gender and prescription behavior of physiciansThe results showed that there was no significant difference in prescription behavior between male and female physicians.Among the male physicians,90.91%(60/66)were prescribing physicians,86.57%(58/67)were female physicians;50.00%(33/66)were male physicians:47.76%(32/67)were female physicians:90.57%(58/67)were non antibiotic drugs 01%(60/66),83.58%(56/67)of female physicians prescribed non antibiotic drugs;74.24%(49/66)of male physicians prescribed Chinese patent medicine,and 76.12%(51/67)of female physiciansThe average price of prescriptions in male physicians was 38.55 ± 23.23 yuan,while that of female physicians was 38.72± 26.93 yuan;The average price of antibiotics in male physicians was 5.55 ± 7.23 yuan,and that in female physicians was 6.20 ± 8.05 yuan.The average price of non antibiotic drugs in male physicians was 33.00 ± 22.29 yuan,and that in female physicians was 32.52± 26.06 yuan.The average price of Chinese medicine in male physicians was 15.88 The average price of non antibiotic drugs in female physicians was 15.64 ± 16.75 yuan.(4)Altruism and other medical behaviors of physiciansThis study found that some other medical behaviors of physicians were related to social altruism.There were statistically significant differences in the overall score of patients’ medical experience,the score of possibility of recommending the physician to their parents and the time of diagnosis and treatment between the pure altruism group,ego-altruism group and egoism groupThe overall score of the patient’s medical experience and the possibility of recommendation can best reflect the patient’s medical experience.We compared the scores of the three groups of physicians in these two aspects:The overall score of medical experience in pure altruism group was 6.1 5 ± 1.65,that of ego-altruism group was 5.65± 1.63,and that of ego-altruism group was 5.06 ±1.63The score of recommendation for physicians’ clinics in pure altruism group was 5.42±2.17,that of ego-altruism group was 4.86± 1.62,and that of patients in ego-altruism group was 4.34 ± 1.90.The average diagnosis and treatment time of patients in pure altruism group was 9.21±3.38 minutes,that of patients in ego-altruism group was 7.12 ± 3.45 minutes,and that of patients in ego-altruism group was 7.27 ± 4.05 minutes(5)Gender and other medical behaviors of physicians The time of diagnosis and treatment is related to patients’ satisfaction and physicians altruistic preference.We compared the time of diagnosis and treatment between male and female physicians.The average time of diagnosis and treatment in male physician’s clinic was 7.06±3.87 min.and that of female physician’s clinic was 8.63± 4.15 min.ANOVA was used to analyze the diagnosis and treatment time of male and female physicians,and the difference between the two groups was statistically significant.Conclusion and policy recommendationsThrough the method of experimental economics.this study analyzes the altruistic level of physicians in social norms,the level of altruism in medical situations,gender and the relationship between physicians’ prescription behavior,and discusses the impact of physicians’ social altruism level on diagnosis and treatment behavior.Finally,the follwing conclusions are drawn:(1)private clinic physicians’ diagnosis and treatment process for common cold needs to be standardized,for example,the diagnosis and treatment process is not standardized The use of antibiotics was not standardized,ribavirin was used illegally,and the demand was obvious.(2)The social altruism of physicians in private clinics is related to altruism in medical situations.Physicians with pure altruism preference performed better than physicians with ego-altruism preference and egoism preference in terms of antibiotic use.drug type,drug price,patient satisfaction and treatment time.Although the patients’ satisfaction of physicians with ego-altruism preference is higher than that of physicians with egoism preference,their performance in antibiotic use,drug type and drug price is worse than that of physicians with egoism preference.(3)The gender of physicians in private clinics is not related to their prescribing behavior,but related to the time of diagnosis and treatment.Female physicians spend more time on diagnosis and treatment than male physicians.Based on the conclusion of this study,we put forward the following policy recommendations:(1)further strengthen the supervision of private clinics,promote the use of anonymous audit.(2)Adjust and optimize the current medical system.(3)Introduce commercial medical insurance or social security into private clinics,and the cost of medical care for residents is reduced through the supervision of third parties.(4)Strengthen the training and education of the correct treatment of common cold,reduce the phenomenon of nonstandard use of antibiotics.(5)Improve the altruism level of physicians and promote the health benefits of patients. |
PDF Full Text Request