利用与探索：知识溢出如何塑造医疗实践与创新

Improving public service quality is a central challenge in developing countries. A common policy tool is to transfer expertise and protocols to lower-tier institutions, with the expectation that such spillovers improve both current performance and long-term innovative capacity. We study this policy logic using a Chinese reform that mandated knowledge transfer from elite to lower-tier hospitals. Our analysis combines a novel measure of lower-tier hospitals’ alignment with elite hospitals’ clinical practice, developed with a large language model applied to clinical texts and prescription decisions, with measures of physicians’ exploratory activity based on academic publications. Using a difference-in-differences design, we find that the policy increased practice alignment at targeted hospitals by 0.29 standard deviations, yielding immediate efficiency gains. At the same time, this gain in exploitation was accompanied by a decline in exploration: physician academic output fell, with publication counts declining by 7% and citation impact by 13%. Our findings highlight that policies promoting existing knowledge can close practice gaps and improve care efficiency, while also creating a potential trade-off with professionals’ incentives to generate new knowledge.