It has been well known that no country can afford to provide all the medical care people demand for. Persistent growth in health care expenditures has been a political and economic issue in developed and developing countries, so dose China. There have been many explanations as to increase in the health expenditures, such as aging population、 case-mix, insurance and new medical technologies. Many health economists suggested that technology innovation is the main driving force of increasing medical costs. As Newhouse (1992) indicated a half or three quarters increasing health expenditures can be explained by the new medical technologies adoption. Previous studies mostly focus on medical technology purchase, which does not shed much light to cost containment. Few analysis focus on the determination of medical technology adoption. Through literature review, this thesis illustrates the determinants technology adoption and how they affect medical expenditure. In doing so, we hope to provide information to help the government design appropriate technology regulation and cost-containment policy. Based on literatures review, we hypothesis that exogenous shock affects physician's medical technology adoption. When fertility rate decline, the cesarean delivery rate obviously increased in the next year. Physician chose a more highly reimbursed treatment, cesarean delivery, in order to maintain their incomes. It was tested in 12,433 cases in the department of gynaecology and obstetrics at a Chinese hospital between year 2000 and 2006. There is a strong positive relationship between the cesarean delivery rate and the income effect. Through a description analysis, some conclusion can be made. First, it is important to build up a more complete evaluation system to regulate the use and purchase of new technologies, even if they are cost-effective. Secondly, the regulation would be best implemented base on the clinical guidelines in order to reduce the symptom-less cesarean section delivery. Finally, reduction in the price differentials between new and old technologies would help control the reward to physician's "unnecessary" adoption of new and expensive technologies. Key words: New medical technology, Adoption costs, Supplier-induced demand iy

目前,持续增长的医疗支出已经成为大多数发展中国家和发达国家的政治经 济议题。中国和其它国家同样面临医疗费用急剧上涨的问题,增长速度之快远远 超过个人和社会经济的承受力。如果不控制这种上涨的趋势,将会给社会、家庭 带来更加沉重的负担。 导致医疗费用快速增长的因素有很多,例如:人口老龄化、疾病组成中慢性 病的比例越来越高、医疗保险的介入等等。然而,大部分的健康经济学文献都赞 成新医疗技术的使用才是医疗费用快速度增长的最主要原因。哈佛大学讲座教授 Newhouse,经过对大量资料的仔细地验证后,指出在医疗费用增长中有50%甚 至75%可归因于新医疗技术的广泛使用。 过去的研究主要集中在从宏观上分析新医疗技术的使用如何导致医疗费用 的增长,或者研究如何购买和为什么要购买新的医疗技术,但是这些研究结果都 不能有效地控制医疗费用的增长。很少有研究从医疗技术的使用成本和医生诱发 需求行为这两方面来分析。理论上,新医疗技术会给患者带来好处,但是医疗资 源是有限的,我们不能无限制地使用。因此,必需要对新医疗技术的使用进行管 制。医生是医疗技术的使用者,为了更好地了解医生的行为,本文重点从医疗技 术的使用成本的层面进行探讨,全面地分析影响医生选择使用医疗技术的决定因 素,并引入诱发需求理论,解释医生为了维持自身的收入,而向患者提供过量的 医疗服务的现象。从根本上了解医疗费用增长的机制,帮助政府及卫生部门设计 医疗技术的使用规范和控制医疗费用的策略。 国外文献表明:当外部因素改变,尤其是这些因素直接影响医生主要收入来 源时,可以影响医生选择使用医疗技术的行为。为了进一步的研究,本文收集了 中国沿海某家二甲医院 2000-2006年妇产科病例 12,433例。并且,证实在了 该医院的剖宫率和妇产科医生收入效应之间有很强的正性关系。当生育率下降, 医生会更多地选择使用保险赔偿较高的剖宫产手术来维持收入。 通过对医生使用医疗技术的影响因素和医生诱发需求行为的深入分析,我们 建议政府和相关的卫生部门:首先,在国内要建立更全面和完整的医疗技术评估 机构,符合成本效益的新技术才引进和使用。其次,加强规范医疗技术的使用, ii 澳门大学硕士学位论文 尤其要完善对医院临床医疗技术使用的规范指引,这样才能减少类似无指症剖宫 产手术的发生。最后,改变支付制度。尽可能地减少医生使用新旧医疗技术之间 的收入差额。从而控制医生通过使用费用高昂的新医疗技术,获得较高的收入。 这样才能在减少医疗费用增长的同时使卫生资源更合理的配置。 关键词:新医疗技术 使用成本诱发需求 iii