Abstract: Since the introduction of the New Healthcare Reform, the Chinese government has been steadfast in addressing the issues of “difficulties and high costs of medical treatment” faced by the public. To address the issues of the unreasonable income structure of public hospitals and the distorted allocation of medical industry resources, a new performance assessment indicator system was launched nationwide in 2019. The system uses indicators such as a proportion of medical service income to assess the rationality of the hospital income structure. As a result, the focus of Healthcare Reform has shifted from reducing the proportion of drug income to improving the quality of medical services provided by medical staff. In the face of sustained growth in China’s medical and healthcare costs, it is necessary to explore the root causes of doctors’ over-treatment behaviors in public hospitals and investigate the mechanism of the impact of medical service income proportion regulation on doctors’ “compensation-type over-treatment behaviors” and patients’ medical decision-making. Therefore, what is the fundamental etiology of the over-treatment behavior exhibited by healthcare providers in Chinese public hospitals? What is the optimal and rational spectrum of the medical service income proportion, which the government should regulate to fundamentally mitigate the problem of overuse of medical services? Which factors impact the doctors’ over-treatment behavior under the constraints of medical service income proportion regulation? These queries are pivotal in fundamentally alleviating the predicament of “difficulties and high costs of medical treatment” and enhancing the current status of overutilization of medical care among physicians in public hospitals in China.
This paper presents an evolutionary game theory model to investigate whether the over-treatment behavior can be mitigated by increasing the price of medical services in public hospitals. During the process of solving the evolutionary game model, we initially examine the evolutionarily stable strategies of patients and their correlation with the variations in the strategies of doctors. By establishing the Jacobian matrix, we study the evolutionary stable strategies of the system under different initial conditions and provide an effective range of the medical service income proportion regulation. Additionally, we construct a net income indicator for doctors and examine the factors that affect the doctors’ over-treatment behavior, including medical costs, doctors’ revenue performance factors, doctors’ disguise costs, doctors’ professional ethics and altruistic psychology, a government regulation of medical service income proportion, and doctors’ diagnostic service fees. Our study results demonstrate that regulating the proportion of medical service income can reduce the doctors’ over-treatment behavior within a certain range. However, when the policy reference value exceeds this range, doctors may opt to engage in the over-treatment behavior. Taking factors such as doctors’ professional ethics and altruistic psychology and the imbalance of public hospital income structure into account, we observe that the over-treatment behavior of doctors is essentially a type of “compensatory over-treatment behaviors” caused by the gap between medical service prices and the actual labor value of medical staff. A regulation of the proportion of medical service income can address this type of over-treatment behaviors by increasing the prices of doctors’ diagnostic services and expert consultation fees. Moreover, the greater the degree of reward or punishment for the medical service income proportion, and the higher the diagnosis and service fees, the more likely doctors are to choose appropriate medical treatments and get the pay corresponding to the actual labor value. Based on these findings, we propose three recommendations for the government and relevant departments. Firstly, the government should actively promote the reform of public hospitals and establish a reasonable reference value range for the proportion of medical service income regulation. Secondly, public hospitals should provide regular education and training for their employees and create mechanisms for the hospital information disclosure and online evaluation of doctors to enhance the trust between doctors and patients. Finally, relevant departments should collaborate to encourage medical technological innovation and enhance a sense of achievement for medical staff. In summary, this study provides valuable insights into the evolution of doctor-patient relationships and the factors influencing doctors’ strategic decisions. The implications of these findings are significant for policymakers and public hospital management to enhance the quality and efficiency of medical services and establish a mutually beneficial doctor-patient relationship.

Key words: drug proportion, medical service income proportion, public hospitals, compensatory over-treatment, evolutionary game

摘要： 新医改以来,政府一直将解决百姓“看病难、看病贵”问题作为工作重点。随着单一药占比考核指标被取代,公立医院绩效考核体系中的医疗服务性收入占比指标逐渐成为遏制“补偿型过度医疗”行为的重要抓手。本文建立服务性收入占比管制下医患演化博弈模型,探索政策管制的有效区间,研究影响医生过度医疗的关键因素。结果表明:政府对服务性收入占比的管制能够在一定范围内制约医生的过度医疗行为;此外,在服务性收入占比管制下,合理医疗成本越高、医生收入绩效系数越低、伪装成本越高、职业操守或利他心理越强、服务性收入占比奖惩力度越大、患者病情严重程度越低、诊察服务费用越高,越能促使医生选择合理医疗。试图揭示公立医院医生过度医疗行为的内在根源,为解决百姓“看病难、看病贵”问题及政府制定合理服务性收入占比管制政策提供理论依据。

关键词: 药占比, 服务性收入占比, 公立医院, 补偿型过度医疗, 演化博弈