提高赌注：医生设施投资与代理问题
Raising the Stakes: Physician Facility Investments and Provider Agency
American Economic Review · 2026 · [{"name": "Elizabeth L. Munnich", "affiliation": ["University of Louisville"]}, {"name": "Michael R. Richards", "affiliation": ["Cornell University", "Policy Analysis (United States)"]}, {"name": "Christopher Whaley", "affiliation": ["Department of Health Services", "Department of Health Services"]}, {"name": "Xiaoxi Zhao", "affiliation": ["RAND Corporation"]}]
中文摘要
委托代理问题往往超出传统激励安排所能直接解决的范围。我们考察了这样一种情境：在医生的私人财务利益与患者利益趋于一致之前，医生可能缺乏足够激励去最小化总医疗成本。利用有关医生持有门诊手术中心（即当日手术设施）股权的新数据，我们发现，这些股权持有导致医疗服务从成本更高的竞争性场所发生替代，使每名医生对应的 Medicare 支出降低 10%–40%。我们没有发现这些投资之后出现反常行为的明确证据。相反，我们的研究结果表明，创业活动如何能够间接抑制委托代理问题并提高效率。（JEL D82, D91, G51, I11, I18, L84）
Abstract
Principal-agent problems often extend beyond what can be directly addressed through conventional incentive arrangements. We examine a context where physicians are likely under-incentivized to minimize total medical costs until their private financial interests align with those of patients. Leveraging novel data on physician ownership of ambulatory surgery centers——that is, same-day facilities——we show that these equity holdings cause a substitution away from higher cost, rival settings that lowers Medicare spending by 10–40 percent per physician. We find no clear evidence of perverse behavior following these investments. Instead, our findings demonstrate how entrepreneurial activity can indirectly limit principal-agent problems and improve efficiency. (JEL D82, D91, G51, I11, I18, L84)