Incentives and Pressures: Two Paths for the Medical Market Mechanism in Influencing Doctor Groups

The market mechanism has been gradually introduced into the field of public medical services since the reform and opening up. However, do the direct providers of medical services feel motivated by this and approve that marketization has brought about an increase in their income and social-status level? Apart from previous research that simply emphasize the incentive effect of market mechanism, the current research based on a national survey of Chinese doctors and finds that there are both incentive and pressure paths for the influence of the market mechanism on doctors in the medical principal-agent process. On the one hand, the incentive effect path and the pressure transmission path are asymmetric in structure, where two paths act on doctors with different characteristics and forms differentiation in the doctor groups. On the other hand, the pressure transmission path has two dimensions: internal pressure from hospital organizations and external pressure from patients. Both internal and external pressure variables have a negative interaction effect on the promotion of doctors' status. In addition, the pressure transmission path also has an accumulation effect. Compared with Grade-A tertiary hospitals, the internal external pressure variable significantly reduces the income and status level of doctors in the other hospitals. The research results reveal the complex working conditions and social mentality of doctors under the background of the medical marketization reform, and provide an explanation based on pressure transmission path for some doctors' dissatisfaction towards marketization.