在卫生政策研究领域，中国医疗费用的急剧上升和由供方诱导的需求已是众人皆知。然而，现有文献大多倾向于将普遍存在的过度医疗行为归因于医院和医生的逐利动机，但其实是由根植在中国医疗体系中扭曲的激励机制所造成的。本研究于2013年12月对广东省某市公立医院504名执业医师进行了问卷调查，发现过度医疗行为并不完全由经济诱因支配；医生防范医患纠纷的防御性医疗动机也在很大程度上导致了“大处方”和“过度检查”的防御性行为。回归分析发现，低收入和对于付出和回报落差的不满确实在很大程度上刺激了过度医疗行为。与此同时，医生过往的医患纠纷经历亦显著地影响其防御性医疗行为。本研究揭示了当下紧张的医患关系对于医生行为的重要影响，并就此提出相应的政策建议。%The rapid cost escalation and vast supplier-induced demands in the Chinese health care system are well-known to the health policy research community. The existing literature tends to explain the pervasive overprovision of care by financial incentives of hospitals and physicians. Behind this is a series of misaligned perverse incentives embedded in the Chinese health system for decades. With a survey of public hospital physicians in a city of Guangdong, this study re-veals that the overprovision of care, especially overprescription, is not solely driven by economic incentives, but also by physicians’ motive of avoiding potential disputes with patients, reflecting defensive medical behaviors. The survey was con-ducted in December 2013, which selected 504 licensed physicians by random sampling. The regression analysis suggests that low income and the perceived imbalance between efforts and rewards indeed contribute to physicians’ motivation of de-fensive medicine. In the meantime, their past experiences of medical disputes with patients are also found significantly as-sociated with defensive behaviors. This study has revealed the critical impacts of the escalating tension between doctors and patients in distorting physician’ behaviors, and lays out policy recommendations.
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