Research on Performance Incentive Mechanism of General Practitioners under the Consideration of Reputation Effect

Abstract BackgroundIn China, General practitioners (GPs) have a weaker reputation than specialists, which leads to their low professional identity. Therefore, GPs’ reputation is a bottleneck restricting their participation in skills training and the realization of the service value of community health centre. Because the GPs’ reputation accumulation can only rely on the improvement of personal skills ,it is necessary to combine the improvement of medical skills to the future economic interests of the GPs, and establishing an effective dynamic reputation incentive mechanism. The purpose of this paper is to explore the dynamic reputation incentive mechanism for GPs, and analyze its performance. MethodsIn this paper, a dynamic incentive model of the GPs in two stages under the effect of explicit and implicit reputation is established and solved by using game theory and agent-principal theory. ResultsThe explicit reputation affects GPs’ determined incomes mainly through fixed awards, and the medical effort input in Stage 1 decreases with the performance award in Stage 2 under the reputation mechanism; the increase of the implicit reputation coefficient can improve the medical performance output, the performance award level and the total value of medical service value, and the explicit reputation correction factor plays the opposite role; when the implicit reputation coefficient and explicit reputation correct factor meet certain conditions, the implementation of reputation incentive can lead to the Pareto effect of GPs’ medical effort and performance awards.Conclusion(1) explicit reputation mainly affects GPs’ deterministic income in Stage 2 by changing the fixed benefits; (2) the medical efforts in the Stage 1 depend on the unit performance incentive coefficient in both stages, and show a certain ratchet effect; (3) implicit reputation can help to improve the level of medical efforts at each stage; (4) the reputation uncertainty will reduce the level of medical efforts and unit performance incentive at each stage; (5) when the explicit reputation correction coefficient is lower than a certain threshold, the implement of reputation incentive can realize the Pareto effect of medical efforts.