We analyse the effects of two different types of physician remuneration - fee-for-service and fixed salary - on the treatment decisions of general practitioners (GPs) and on patients´ health outcomes. Using rich Norwegian register data during the period 2009-2013, we focus on GP locums working in a succession of temporary positions, which allows us to observe the same GPs working under different remuneration schemes within a relatively short period of time. We find that GPs respond strongly and consistently to changes in remuneration type. Compared with fixed salary, GP payment by fee-for-service leads to an increase in the supply of consultations and a higher provision of medical services (along several dimensions) per consultation. This has also signficant implications for patients´ health outcomes. The probability of experiencing an emergency admission to hospital shortly after a GP consultation is close to 20 percent lower if the GP is paid by fee-for-service instead of fixed salary. Overall, our analysis suggests that fixed-salary remuneration leads to underprovision of primary care.

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报酬类型如何影响医师的行为？固定工资与按服务收费

我们分析了两种不同类型的医生报酬-服务费和固定工资-对全科医生（GPs）的治疗决策和患者健康结局的影响。利用2009-2013年期间丰富的挪威注册数据，我们将重点放在在一系列临时职位上工作的全科医生社区中，这使我们能够在相对较短的时间内观察到同一全科医生在不同的薪酬方案下工作。我们发现，全科医生对薪酬类型的变化有强烈而一致的反应。与固定薪资相比，按服务付费的全科医生薪酬导致咨询次数增加，并且每次咨询都提供更多的医疗服务（沿多个方面）。这对患者的健康结局也具有重要意义。如果全科医生以服务付费而不是固定薪资支付费用，则在全科医生咨询后不久就可以紧急入院的可能性降低了近20％。总体而言，我们的分析表明，固定工资薪酬导致基层医疗服务不足。