公共部门与信任品的质量排名信息披露机制设计:以中国医疗服务体系为例
陈剑锋
北京大学国家发展研究院
4/21/2014 10:53:37 PM
摘要:
信息披露是当今经济学发展的一个重要分支,针对现有文献的不足,本文将以我国医疗服务体系为例,研究公共部门和信任品的信息披露机制(quality disclosure)的设计问题,以及医疗信息技术(health IT)手段对该机制的保障作用,从而探索公共部门竞争形态的创新方式。为此,在介绍现有“事后结果披露+群体披露+只奖不惩+信息填报”机制的原理和局限的基础上,本文重新设计了一套“事前自报+结果监管+差异管理+有奖有惩”的信息披露机制:让医院自我披露质量排名信息并获得相应报酬,同时为了让医院说真话,政府需要对医疗结果进行监管,并对每一位次上的医院进行差异化管理,排名越高,监管越严,以及对没有达到标准的医院进行行政处罚。该机制的一个核心理念是设计一种新的竞争机制:通过设置差异化监管标准,让真正质量好的医院在质量排名的竞争中占据优势,以此达到真实披露的目标。实践中,这样的机制可以通过“市场定价+行政监管”或“按人头预付+按绩效支付”的混合支付合约两种方式实现。在此基础上,本文还分析了风险信息不精确带来的医院挑选病人和虚报信息的策略行为,以及医疗信息化在解决这些问题方面的作用。最后讨论了公立部门信息披露问题和大数据时代对该机制设计的意义。
关键词: 
医疗服务体系 质量信息披露 信息精确性 医疗信息化
Abstract:
Quality disclosure is a frontier theory of economics. Against current theories’ limitations, in this paper, I have designed a new quality disclosure mechanism for credence goods in public sectors based on health care; and I have analyzed the risk information inaccuracy problem and health IT’s effect on constraining hospital’s risk selection and dishonest reporting behavior. This new mechanism is based on hospitals’ self-reporting ex ante and government’s differential supervision ex post, which I proved can overcome the traditional mechanism’s shortcomings, in terms of information inaccuracy. The rationale is designing a market mechanism to make the good hospital more competitive. Practically, such a mechanism can be either implemented in a patient-driven competition as pricing autonomy and regulation, or in a payer-driven competition as a negotiable mixed contract of capitation and pay for performance. Finally, we give an open discussion on issues of public sector quality disclosure and big data.
Keyword: 
Delivery System, Quality Disclosure, Information Accuracy, Health Information Technology