Research On The Mechanism Of Occurrence And Prevention Of Doctors' Moral Hazard Behavior

There are some problems in China's medical services,such as the increasing medical expenses and emerging medical risks,which lead to the tense relationship and the prominent contradiction between doctors and patients.On the one hand,it is difficult and expensive for patients to seek for medical services,which has become a major obstacle to the people's livelihood and economic development in China;on the other hand,the doctor-patient disputes have evolved into vicious incidents,which has led to the deterioration of doctors' vocational experience.Asymmetric information between supply and demand features medical industry,and therefore doctors,as the agents,are prone to moral hazard behavior in the process of diagnosis and treatment.In this regard,there has been some research on the macro level of institutional mechanism and the meso level of management system,but there is still destitution of research on its occurrence mechanism at the micro level based on the perspective of individual doctors.This study amalgamated methods of qualitative research and quantitative research.Firstly,through literature research and theoretical analysis,the concept of doctor moral hazard was defined,and the differences among doctors' moral hazard,induced demand in medical services,excessive treatment and defensive medical treatment were compared.Then,the paper utilized grounded theory to gain the types and influencing factors of doctors' moral hazard behavior,and obtained the specific connotation of each type.Through theoretical analysis,the relationship between the influencing factors has been obtained,and the concept model constructed.After the operational definition of each influencing factor,the initial measurement items of each variable were formed.Then,according to the principle and process of questionnaire preparation,the initial questionnaire was formed.After the pre-test and the validity reliability test,a scientific questionnaire was established.Finally,the data were obtained by questionnaire survey,reliability and validity analysis were conducted,the hypothesis of which was tested by structural equation model to obtain a series of research conclusions.First,the study defined the connotation and dimensions of doctors' moral hazard.For the moral hazard in medical services,most of the antecedent researches are from the perspectives of moral hazard in medical insurance,induced demand in medical services,defensive medical behavior,and excessive medical behavior,basically behavioral moral hazard behavior.This study,based on the fundamental attribute of moral hazard,introduced non-behavioral moral hazard,defined the concept of doctor moral hazard,and distinguished the moral hazard of doctors as passive or active way,and different degrees of damage.Grounded theory was utilized to obtain six types with specific manifestations and characteristics and eighteen sub-types of moral hazard behavior,especially the non-behavioral doctors' moral hazard,and complemented the specific content of the malpractice in doctors' moral hazard.Secondly,this study deeply analyzes the influencing factors of doctors' moral hazard behavior and the relationship among them.Through theoretical research and grounded research,the influencing factors of doctors' moral hazard behavior could be analyzed from six aspects: motivation dimension,opportunity dimension,rationalization dimension,ability dimension,exposure dimension and punishment dimension.Through exploratory factor analysis,it is found that the terms of the six influencing factors are classified as an independent factor;through internal consistency analysis,correlation analysis and confirmatory factor analysis,the developed scale has good convergence validity,discriminant validity,aggregate reliability and internal reliability.Thirdly,this study revealed the mechanism of the moral hazard behavior of doctors.Motivation,opportunity,rationalization and ability have positive impact on intention,and doctor's moral hazard intention has a positive impact on doctor's moral hazard behavior.The mediating effect of intention is significant,and intention plays a mediating role among motivation,rationalization,opportunity,ability and behavior.Comparatively speaking,the mediating effect of intention on opportunity to behavior is the most obvious,and the mediating effect of intention on ability to behavior is the least obvious.The regulatory effect of exposure was significant.Hospital level,doctor's age,doctor's position and doctor's title have interference effect on doctor's moral hazard behavior.Finally,this study established the prevention mechanism of doctors' moral hazard behavior.In view of the lack of systematic prevention and prone to loopholes,wrangling and other problems,this paper makes a systematic analysis based on the theoretical framework of the occurrence mechanism of doctor's moral hazard behavior established in this paper,and sorts the factor loads of various influencing factors.The research shows that: the pressure from missed diagnosis and misdiagnosis is the primary motivation of doctors' moral hazard behavior,the low degree of knowledge transfer between doctors and patients is the main reason for doctors' moral hazard behavior opportunity,the safety cost is the primary reason for doctors' moral hazard behavior,the strong persuasive ability of doctors to patients is the main advantage,and the hospital supervision and inspection is the most influential exposure means for doctors Professional punishment has the greatest deterrent effect on doctors.The“1+3+6” prevention mechanism of doctor's moral hazard behavior was put forward synthetically: the prevention target is determined by the type of behavior and the severity of the consequences;the prevention system is constructed from three levels of macro,meso and micro;the prevention measures are formed from six perspectives of motivation,opportunity,ability,rationalization,exposure and punishment,forming a new integrated prevention network.To sum up,this study scientifically defined the concept of doctors' moral hazard,constructed the conceptual model of the occurrence mechanism of moral hazard behavior of individual doctors,and provides empirical support for theoretical research,has enriched the theoretical research of medical behavior,and serves as practical guidance for prevention of moral hazard behavior of doctors.