Physician agency in China: evidence from physicians’ responses to financial pressure during the COVID-19 pandemic
Why this work is in the frame
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Bibliographic record
Abstract
This paper examines how rural primary care physicians in China adjusted their practice patterns to pandemic-related financial pressures under a capitated global-budget model. Using township-hospital data, we find increased prescribing of Traditional Chinese Medicine (TCM) decoction pieces, with effects concentrated among habitual prescribers rather than converting occasional users into regular prescribers. Physicians also reduced both the number of drugs prescribed and the volume of services provided to cost-sharing outpatients, producing a 5% decline in average insurance payments per outpatient visit and potentially generating a greater surplus within the global-budget pool. By contrast, we observe no significant changes for self-paying outpatients, suggesting limited scope for physician-induced demand. These results underscore the role of physician agency in healthcare provision and highlight the importance of aligning financial incentives with policy goals. While drug reforms and managed-care models have contained expenditures, challenges remain in achieving adequate coverage for rural residents.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it