关键词: 医患关系, 激励机制, 信任商品, 委托代理理论, 监督信号

Abstract: In recent years, China’s healthcare service system has made significant progress in its development and service capabilities. However, the persistent issue of strained doctor-patient relationships remains unresolved. Despite implementing several reform measures, the current level of harmony in China’s doctor-patient relationships remains relatively low. Recent incidents of violence against medical professionals have prompted scholars to refocus on the micro-level of doctor-patient relationships-the trust. Establishing effective doctor-patient trust and improving the doctor-patient relationship are a key issue for China.
Doctor-patient trust primarily refers to the patient’s trust to and reliance on doctors, specifically the conscious belief and willingness to entrust themselves through actions. Patient behavior can be explained in two aspects: Firstly, their purchasing behavior towards medical services, which are considered as credence goods; Secondly, their act of entrusting doctors to address their health issues, establishing a principal-agent relationship. Speculative behavior by medical professionals hinders the establishment of trust, while appropriate healthcare service incentive mechanisms can effectively curb adverse behavior. Therefore, this article aims to establish an incentive model for healthcare services based on theories of credence goods and principal-agent relationships, and studies the best incentive contract to restrain medical speculation. First, considering the influence of patient types, economic incentives, and psychological factors, we establish an incentive model for doctor-patient trust and study the composition of its optimal solution. Then, we introduce the patient’s supervision signal to the original model and study the changes in the doctor’s speculative behavior.
Through theoretical research and numerical analysis, we find that the best incentive degree is mainly composed of the cost and marginal output rate of the doctor’s effort, the incentive degree will affect the doctor’s effort level and the probability of overcharging, and the patient’s supervision signal also has a significant inhibitory effect on the doctor’s speculative behavior. Additionally, this study also draws some conclusions and insights for hospitals and government. Hospitals should pay attention to patients’ information feedback and deal with it in a timely manner. They can also provide more formal channels for patients to obtain medical knowledge, such as publishing popular science articles. At the same time, the relevant government departments should provide formal and effective supervision and feedback channels, such as clarifying the medical service complaint hotline and establishing a unified network complaint platform. In addition, the mass media should also ensure the accuracy of medical information published on the Internet to prevent the spread of misinformation. At present, the salary system of the medical industry is facing reform. The type of patients received by doctors can be included in the consideration of the fixed salary of doctors. Different hospitals need to design incentive contracts based on their own characteristics. Moreover, different patient types also mean different effort costs, workload, technical difficulty, etc., which can also be used as measurement indicators for the setting of doctors’ salaries.
The current study has not yet taken into account the situation where patients choose to reject a doctor’s treatment plan and seek a second opinion. Additionally, it has not extensively considered the influence of additional information such as patients’ economic status or social standing. These are areas that can be further explored in future research.

Key words: doctor-patient relationship; incentive mechanism; credence goods; principal-agent theory; supervision signal