Abstract：
The Australian government, through Medicare, defines the type of medical specialist services it covers and subsidizes, but it does not regulate prices. Specialists in private practice can charge more than the fee listed by Medicare depending on what they feel \'the market will bear\'. This can sometimes result in high and unexpected out-of-pocket (OOP) payments for patients. To reduce pricing uncertainty and \'bill shock\' faced by consumers, the government introduced a price transparency website in December 2019. It is not clear how effective such a website will be and whether specialists and patients will use it. The aim of this qualitative study was to explore factors influencing how specialists set their fees, and their views on and participation in price transparency initiatives. We conducted 27 semi-structured interviews with surgical specialists. We analysed the data using thematic analysis and responses were mapped to the Theoretical Domains Framework and the Capability, Opportunity, Motivation and Behavior model. We identified several patient, specialist and system-level factors influencing fee setting. Patient-level factors included patient characteristics, circumstance, complexity, and assumptions regarding perceived value of care. Specialist-level factors included perceived experience and skills, ethical considerations, and gendered-behavior. System-level factors included the Australian Medical Association recommended price list, practice costs, and supply and demand factors including perceived competition and practice location. Specialists were opposed to price transparency websites and lacked motivation to participate because of the complexity of fee setting, concerns over unintended consequences, and feelings of frustration they were being singled out. If price transparency websites are to be pursued, specialists\' lack of motivation to participate needs to be addressed.
摘要：
澳大利亚政府,通过医疗保险，定义了它涵盖和补贴的医学专家服务的类型，但它不调节价格。私人执业专家可以收取比Medicare列出的费用更多的费用，具体取决于他们认为“市场将承受”的费用。这有时会导致患者的高和意外的自付(OOP)支付。为了减少消费者面临的定价不确定性和“账单冲击”，政府于2019年12月推出了价格透明度网站。目前尚不清楚这样一个网站的有效性以及专家和患者是否会使用它。这项定性研究的目的是探索影响专家如何设定费用的因素，以及他们对价格透明度举措的看法和参与。我们对外科专家进行了27次半结构化访谈。我们使用主题分析分析了数据，并将响应映射到理论域框架和能力，机会,动机和行为模型。我们确认了几个病人,影响费用制定的专家和系统级因素。患者水平因素包括患者特征，环境,复杂性，以及关于护理感知价值的假设。专家级别的因素包括感知的经验和技能，伦理考虑，和性别行为。系统级因素包括澳大利亚医学协会推荐的价格表，实践成本，以及供需因素，包括感知的竞争和实践位置。由于费用设定的复杂性，专家反对价格透明网站，缺乏参与的动力，对意外后果的担忧，和沮丧的感觉，他们被挑出来。如果要追求价格透明的网站，需要解决专家缺乏参与动力的问题。
