中文摘要
如果过度拥挤会损害医疗服务质量,那么鼓励更多人使用服务所产生的效果便并非显而易见。影响将取决于边际进入者能否受益,以及其收益是否足以抵消其施加于边际内使用者的拥挤外部性。我们构建了一个一般均衡模型来形式化这些观点,并通过研究印度一项为在医疗机构分娩的女性提供支付的计划 JSY,对其进行实证检验。我们发现证据表明,JSY 提高了医疗体系能力较低地区的围产期死亡率,在较为复杂的分娩中尤为有害,降低了机构产后护理的质量,并对其他服务产生了有害的溢出效应。
Abstract
If overcrowding harms health care quality, the impacts of encouraging more people to use services are not obvious. Impacts will depend on whether marginal entrants benefit and whether they benefit enough to offset the congestion externalities imposed on inframarginal users. We develop a general-equilibrium model that formalizes these ideas. We examine them empirically by studying JSY, a program in India that paid women to give birth in medical facilities. We find evidence that JSY increased perinatal mortality in areas with low health-system capacity, was particularly harmful in more-complex births, reduced the quality of facilities' postnatal care, and generated harmful spillovers onto other services.