医疗健康管理文献选登

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今日转载对外经贸大学国际商学院公众号UIBE全球营销首发的关于医疗和健康管理的几篇文章，供感兴趣的市场营销学者和其他读者学习参考。

1、【MkSc 1】医院广告对病人需求和健康结果的影响

The Impact of Hospital Advertising on Patient Demand and Health Outcomes

作者：Tongil “TI” Kim, Diwas KC

Marketing Science, 2019, Articles in Advance. DOI: 10.1287/mksc.2019.1153

Abstract: 

Does hospital advertising influence patient choice and health outcomes? We examine more than 220,000 individual patient-level visits over 24 months in Massachusetts to answer this question. We find that patients are positively influenced by hospital advertising; seeing a television advertisement for a given hospital makes a patient more likely to select that hospital. We also observe significant heterogeneity in patient response depending on insurance status, medical conditions, and demographic factors, like age, gender, and race. For example, patients with more restrictive forms of insurance are less sensitive to advertisements. Our demand model allows us to study the impact of a ban on hospital advertising, which has been recently considered by policy makers. We find that banning hospital advertising can hurt patient health outcomes through increased hospital readmissions. This is because hospital advertisements drive patients to higher-quality hospitals, which tend to advertise more and have lower readmission rates. However, we do not find a significant change in the overall mortality rate.

摘要：

医院广告是否影响病人的选择和健康结果?为了回答这个问题，我们对马萨诸塞州超过24个月的22万名患者进行了调查。我们发现，医院广告对患者有积极的影响：看到某家医院的电视广告会让病人更有可能选择这家医院。我们还观察到，根据保险状况、医疗条件和人口统计因素(如年龄、性别和种族)，患者的反应存在显著的异质性。例如，保险形式越严格的病人对广告越不敏感。我们的需求模型使我们能够研究禁止医院广告的影响，而这正是政策制定者最近也在考虑的问题。我们发现，禁止医院广告可能会增加再入院人数，从而损害患者的健康结果。这是因为医院广告将病人吸引到高质量的医院，而高质量的医院往往广告更多，再入院率更低。然而，我们并没有发现总体死亡率的显著变化。

关键词：

医疗（health care），广告（advertising），实证产业组织方法（empirical IO methods），内生性（endogeneity），公共政策（public policy），结构模型（structural models）

2、【MkSc 2】医疗行业的质量信息披露和患者再分配：来自心脏手术报告卡的证据

Quality Information Disclosure and Patient Reallocation in the Healthcare Industry: Evidence from Cardiac Surgery Report Cards

作者：Tae Jung Yoon

Marketing Science, 2019, Articles in Advance. DOI: 10.1287/mksc.2018.1146

Abstract: 

In a healthcare industry with capacity constraints, the best healthcare providers are often congested after quality information disclosure. This congestion can lead to the reallocation of urgent patients to low-quality healthcare providers. The reallocation can have a detrimental impact on the overall patient survival rate if sicker patients benefit more from the best providers. This paper provides the first empirical evidence regarding this problem in the context of the publication of cardiac surgery report cards. I find that these report cards can have a negative impact on positive assortative matching between patients and surgeons because of a reallocation of high-risk patients to low-quality surgeons. Despite the quality improvement in response to these report cards, such patient reallocation can still be a problem, conditional on the improved quality, and, thus, should not be ignored.

摘要：

由于医疗行业的容量限制，最好的医疗服务提供者往往在质量信息披露后会超负荷。这种拥挤会导致紧急病人被重新分配给低质量的医疗服务提供者。如果病情较重的患者从最好的医疗机构获益更多，则重新分配可能对患者的总体存活率产生不利影响。这篇论文在心脏手术报告卡片的出版的背景下提供了关于这个问题的第一个经验证据。我发现这些报告卡会对患者和外科医生之间的积极协调性匹配产生负面影响，因为高风险患者被重新分配给了低质量的外科医生。尽管针对这些报告卡进行了质量改进，但这种病人重新分配仍然是一个问题，这取决于质量改进的程度，因此不应忽视。

关键词：

质量信息披露（quality information disclosure），选型匹配（assortative matching），病患再分配（patient reallocation），容量限制（capacity constraint），质量改进（quality improvement），心脏手术报告卡（hospital and surgeon report cards）

3、【MkSc 3】医疗保险市场中的广告

Advertising in Health Insurance Markets

作者：Bradley T. Shapiro

Marketing Science, 2019, Articles in Advance. DOI: 10.1287/mksc.2018.1086

Abstract: 

The effects of television advertising in the market for health insurance are of distinct interest to both firms and regulators. Regulators are concerned about firms potentially using ads to “cream skim,” or attract an advantageous risk pool, as well as the potential for firms to use misinformation to take advantage of the elderly. Firms are interested in using advertising to acquire potentially highly profitable seniors. Meanwhile, health insurance is a useful setting to study the mechanisms through which advertising could work. Using the discontinuity in advertising exposure created by the borders of television markets, this study estimates the effects of advertising on consumer choice in health insurance. Television advertising has a small effect on brand enrollments, making advertising a relatively expensive means of acquiring customers. Heterogeneous effects point to advertising being more effective in less healthy counties, which runs opposite to the concern of cream skimming. Leveraging the unilateral cessation of advertising by United-Healthcare, evidence is provided that the small advertising effect is not explained by a prisoner’s dilemma equilibrium. An analysis of longer-run effects of advertising shows that advertising effects are short lived, further decreasing the potential of advertising to create long-run value to the firm.

摘要：

电视广告对健康保险市场的影响是公司和监管机构都非常感兴趣的。监管机构担心，企业可能会利用广告“撇脂”，或吸引一个有利的风险池，以及企业利用虚假信息占老年人便宜的可能性。公司有兴趣利用广告来获得潜在的高利润的老年人。与此同时，医疗保险是研究广告运作机制的一个有用的背景。利用电视市场边界所造成的广告接触的不连续性，本研究估计了广告对消费者健康保险选择的影响。电视广告对品牌注册的影响很小，这使得广告成为一种相对昂贵的获取客户的手段。异质效应表明，广告在不太健康的国家更有效，这与撇脂所关注的相反。利用联合医疗单方面停止广告所提供的证据表明，广告效果的微小影响并不能用囚徒困境均衡来解释。对广告长期效应的分析表明，广告效应是短期的，这进一步降低了广告为企业创造长期价值的潜力。

关键词：

广告（advertising），保险（insurance），健康（health），联邦医疗保险优惠（Medicare Advantage），逆向选择（adverse selection）

4、【MkSc 4】哪种健康饮食的助推最有效？实地实验的元分析

Which Healthy Eating Nudges Work Best? A Meta-Analysis of Field Experiments

作者：Romain Cadario, Pierre Chandon

Marketing Science, 2019, Articles in Advance. DOI: 10.1287/mksc.2018.1128

Abstract: 

We examine the effectiveness in field settings of seven healthy eating nudges, classified according to whether they are (1) cognitively oriented, such as “descriptive nutritional labeling,” “evaluative nutritional labeling,” or “visibility enhancements”; (2) affectively oriented, such as “hedonic enhancements or “healthy eating calls”; or (3) behaviorally oriented, such as “convenience enhancements” or “size enhancements.” Our multivariate, three-level meta-analysis of 299 effect sizes, controlling for eating behavior, population, and study characteristics, yields a standardized mean difference (Cohen’s d) of 0.23 (equivalent to −124 kcal/day). Effect sizes increase as the focus of the nudges shifts from cognition (d = 0.12, −64 kcal) to affect (d = 0.24, −129 kcal) to behavior (d = 0.39, −209 kcal). Interventions are more effective at reducing unhealthy eating than increasing healthy eating or reducing total eating. Effect sizes are larger in the United States than in other countries, in restaurants or cafeterias than in grocery stores, and in studies including a control group. Effect sizes are similar for food selection versus consumption and for children versus adults and are independent of study duration. Compared with the typical nudge study (d = 0.12), one implementing the best nudge scenario can expect a sixfold increase in effectiveness (to d = 0.74) with half the result of switching from cognitively oriented to behaviorally oriented nudges.

摘要：

我们检验了7种健康饮食助推在实地情境中的有效性，根据它们是否(1)以认知为导向，如“描述性营养标签”、“评估性营养标签”或“增强可见性”;(2)情感导向，如“享乐强化”或“健康饮食召唤”;或者(3)以行为为导向，如“便利增强”或“效果增强”。我们对299种效应大小进行了多元、三水平的元分析，控制了饮食行为、人口和研究特征，得出的标准化平均差异(Cohen’s d)为0.23(相当于- 124千卡/天)。当助推的焦点从认知(d = 0.12， - 64千卡)转移到影响(d = 0.24， - 129千卡)到行为(d = 0.39， - 209千卡)时，效应大小增加。干预措施在减少不健康饮食方面，比增加健康饮食或减少总饮食更有效。效应值在美国比其他国家更大，在餐馆或自助餐厅比在杂货店更大，在包括对照组比不包括对照组的研究中更大。食物选择和消费的效果大小是相似的，儿童和成人的效果大小也是相似的，并且是独立于研究时长的。与典型的助推研究(d = 0.12)相比，实施最佳助推方案的有效性可提高6倍(至d = 0.74)，而从认知导向转向行为导向的效果仅为一半。

关键词：

元分析（meta-analysis），健康（health），食物（food），实地试验（field experiment），助推（nudge），选择构架（choice architecture）

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