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在我国,公立医院大多实施一种强激励型薪酬制度,即固定底薪+分成制,具体表现在医院对科室创收的管理上。基于多任务委托代理模型,若管制者-管理者禁止医生兼差(即走穴),那么医生有可能会在高难度、不确定任务的完成上丧失积极性。相反,若医院管理者适当约束医生将精力投放于边际效用最大化的医疗活动,那么默许兼差也能带来双方效用的提升。因此,对医生采取强政府管制的必要性和可行性都大可怀疑。医院管理者一般远比政府管制者对医疗服务以及相关医生的行止有明显的信息优势,让前者而不是后者对医生兼差实施更适当的激励机制,更为可行。
In our country, public hospitals mostly implement a strong incentive pay system, that is, a fixed basic salary + share system, which is embodied in the management of revenue-generating departments in the hospital. Based on the multitasking principal-agent model, if the regulator-manager forbids the doctor from getting involved (ie, walking through the hole), the doctor may lose his enthusiasm for the completion of difficult and uncertain tasks. Conversely, if hospital administrators properly restrict physicians from focusing on medical activities that maximize their marginal utility, the tacit and impor- tance can also lead to improvements in both utilities. Therefore, the necessity and feasibility of adopting strong government control over doctors are both highly suspect. Hospital administrators generally have far more informational advantages than government regulators have for medical services and related physicians’ delineations, making it more feasible for the former, not the latter, to implement more appropriate incentives for doctor-patient differentiation.