医师区域注册制度的可行性实证研究——基于法经济学的观察
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摘要
区域注册制度与知情报备制度赋予医师多点执业的自我决定权,理论上是助推医师多点执业的利好新政。但实证研究表明,在区域注册制度激励机制下,仍有近一半的医师并不打算积极开展第二执业,医师多点执业可能再次遇冷。从法经济学角度观察,其实质是医师在医疗侵权责任高风险的制度条件下,基于经济人理论及预期效用理论所致的消极防御性医疗,具有制度性、内生性及隐蔽性的特点。就医师多点执业配套制度改革而言,首推完善医疗侵权责任制度,是促进医师多点执业的内在制度逻辑所需,也是医师多点执业核心主体医师群体的首盼。
The regional registration system and informed reporting system provide the physician more self-determination in practicing medicine.Theoretically,there are new policies to promote multi-site practice of physician.However,empirical researches show that under incentive mechanism of the regional registration system,there are still about half of physicians do not intend to actively carry out the second practice,multi-site practice may encounter unpopular situation.From perspective of law and economics,the essence of this situation is that physicians take negative defensive medicine in the high risk medical tort liability system,based on economic theory and expected utility theory,which was characterized as institutionalization,endogeny and concealement.In order to improve doctor multi-site practice system,it should primarily propose the reform of medical tort liability system,which is necessary to improve doctor multi-site practice from system prospective and also the expectations of the doctors who are the core group of multi-site practitioners.
The regional registration system and informed reporting system provide the physician more self-determination in practicing medicine.Theoretically,there are new policies to promote multi-site practice of physician.However,empirical researches show that under incentive mechanism of the regional registration system,there are still about half of physicians do not intend to actively carry out the second practice,multi-site practice may encounter unpopular situation.From perspective of law and economics,the essence of this situation is that physicians take negative defensive medicine in the high risk medical tort liability system,based on economic theory and expected utility theory,which was characterized as institutionalization,endogeny and concealement.In order to improve doctor multi-site practice system,it should primarily propose the reform of medical tort liability system,which is necessary to improve doctor multi-site practice from system prospective and also the expectations of the doctors who are the core group of multi-site practitioners.
引文
[1]董莉.实行医师多点执业需要解决好的若干问题浅析[J].中国卫生事业管理,2014(8):596-599.
[2]沈峥嵘,丁亚鹏,蒋廷玉.多点执业只是“看上去很美”[EB/OL].(2011-08-14)[2018-11-29].http://js.xhby.net/system/2011/08/14/011455209_01.shtml.
[3]顾绚,逯建.医师多点执业意愿影响因素的经济学分析[J].四川大学学报:哲学社会科学版,2017(4):43-50.
[4]何思长,张瑞华,孙渤星,等.医师多点执业政策的认知调查与分析[J].卫生经济研究,2015(2):17-21.
[5]徐袁瑾,谈争,张少明,等.多点执业:公立医院医师的意愿与管理者的应对[J].医学与哲学,2015,36(11B):88-93.
[6]林程凯,陈俊畅,耿仁文.公立医院医师群体对医师多点执业的认知分析[J].医学与哲学,2014,35(5A):60-63.
[7]涂强.责任保险的公益性研究:基于法经济学的视角[J].保险职业学院学报,2009,23(6):60-63.
[8]肖柳珍.防御性医疗的经济分析:兼评《侵权责任法》第63条[J].法学杂志,2012(8):140-144.
[9]肖柳珍.美国医疗过失诉讼对健康保险的影响与借鉴[J].医学与哲学:人文社会医学版,2011,32(7):65-66.
[10]杨立新.《侵权责任法》改革医疗损害责任制度的成功与不足[J].中国人民大学学报,2010(4):9-16.
[11]肖柳珍.医疗保险制度改革的新视角:基于美国医疗过失诉讼与医疗保险关联性的分析路径[J].中国卫生事业管理,2011(7):488-490.
[12]康民.上海探索医患纠纷调解新路[EB/OL].(2016-10-26)[2018-11-29].http://shh.sinoins.com/2016-10/26/content_211493.htm.
[13]陈继芳,白丽萍,梁萍萍,等.医师多点执业研究的文献综述[J].中国医院,2014,18(11):36-38.
[2]沈峥嵘,丁亚鹏,蒋廷玉.多点执业只是“看上去很美”[EB/OL].(2011-08-14)[2018-11-29].http://js.xhby.net/system/2011/08/14/011455209_01.shtml.
[3]顾绚,逯建.医师多点执业意愿影响因素的经济学分析[J].四川大学学报:哲学社会科学版,2017(4):43-50.
[4]何思长,张瑞华,孙渤星,等.医师多点执业政策的认知调查与分析[J].卫生经济研究,2015(2):17-21.
[5]徐袁瑾,谈争,张少明,等.多点执业:公立医院医师的意愿与管理者的应对[J].医学与哲学,2015,36(11B):88-93.
[6]林程凯,陈俊畅,耿仁文.公立医院医师群体对医师多点执业的认知分析[J].医学与哲学,2014,35(5A):60-63.
[7]涂强.责任保险的公益性研究:基于法经济学的视角[J].保险职业学院学报,2009,23(6):60-63.
[8]肖柳珍.防御性医疗的经济分析:兼评《侵权责任法》第63条[J].法学杂志,2012(8):140-144.
[9]肖柳珍.美国医疗过失诉讼对健康保险的影响与借鉴[J].医学与哲学:人文社会医学版,2011,32(7):65-66.
[10]杨立新.《侵权责任法》改革医疗损害责任制度的成功与不足[J].中国人民大学学报,2010(4):9-16.
[11]肖柳珍.医疗保险制度改革的新视角:基于美国医疗过失诉讼与医疗保险关联性的分析路径[J].中国卫生事业管理,2011(7):488-490.
[12]康民.上海探索医患纠纷调解新路[EB/OL].(2016-10-26)[2018-11-29].http://shh.sinoins.com/2016-10/26/content_211493.htm.
[13]陈继芳,白丽萍,梁萍萍,等.医师多点执业研究的文献综述[J].中国医院,2014,18(11):36-38.