通讯作者: 姚强, yaoqianghero@126.com

DOI：10.12201/bmr.202505.00016

A scoping review on the behavioral impact of physician payment methods

• 摘要：目的：系统分析各类医生薪酬支付方式对医疗服务提供行为及结果的影响。方法：采用范畴综述法，以Web of Science和中国知网、维普及万方为数据源，“医生”“薪酬”“支付方式”和“医生行为”等为主题词，系统检索相关文献1695篇，通过制定严格的筛选程序最终纳入70篇相关研究。结果：按项目支付激励医生提供足量服务，但易导致过度医疗；固定薪水与按人头支付有助于控制成本，但易引发服务不足；DRG/DIP在医疗服务数量与质量方面的优势随患者病情加重而减弱。混合支付方式能够有效平衡医疗服务数量与成本，而按绩效支付在医疗质量提升方面总体表现突出。结论：医生薪酬单一支付方式难以实现医疗服务提供行为及结果最优化且质量导向不足，多种支付方式与质量激励相融合的混合支付体系亟待构建。同时，建议深化医保结余薪酬转化机制改革，充分落实公立医院分配自主权，加快建立与医保支付和绩效考核协同的医生薪酬混合支付方式。

  关键词： 医生薪酬; 支付方式; 激励机制; 医生行为; 范畴综述

   

  Abstract: Objective： To systematically analyze the impact of various physician payment methods on medical service delivery behavior and outcomes. Methods: Based on the scoping review method, documents related to “physician”, “compensation”, “payment method”, and “physician behavior” were retrieved from Web of Science, CNKI, VIP, and WanFang databases, and finally included based on scientific screening standards and process. Results: Fee-for-service encourages physicians to deliver an adequate volume of services but is susceptible to overtreatment; salary and capitation assist in controlling costs but can lead to insufficient service provision; the advantages of DRG/DIP in the quantity and quality of medical services weaken as the patients condition worsens. Mixed payment methods can effectively balance the quantity and cost of medical services, while pay-for-performance is generally outstanding in improving quality. Conclusion: It is difficult for a single payment method to achieve the optimization of medical service delivery behavior and outcomes. A mixed payment system that integrates multiple payment methods with quality incentives must be established urgently. At the same time, it is recommended to deepen the reform of the mechanism for converting medical insurance balance into physician compensation, fully implement the allocation autonomy of public hospitals, and accelerate the establishment of a mixed physician payment method that is coordinated with medical insurance payment and performance appraisal.

  Key words: Physician Compensation; Payment methods; Incentives; Physician Behavior; Scoping Review

  提交时间：2025-05-19

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
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• 序号	提交日期	编号	操作
  1	2025-04-03	bmr.202505.00016V1	下载

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