摘要
过度医疗是我国医疗改革关注的重要问题之一,为有效遏制,国家继价格管制、取消药品加成等措施后,新出台药占比管制政策.基于此,本文构建药占比管制下医患行为的演化博弈模型,根据复制动态方程得到医生与患者的行为演化规律与稳定策略,分析合理医疗成本、过度医疗较合理医疗增加的成本比率、医疗总费用绩效系数与患病严重程度等因素对医生诊疗策略的影响.研究结果显示:药占比管制并不总是抑制过度医疗,其存在一重要跃迁点,药占比参考值低于该跃迁点时,反而会引发过度医疗.特别发现,在药占比管制下过度医疗与患病严重程度密切相关,医生对轻症患者更倾向于过度医疗.依据研究结论,本文对药占比指标设置,轻疾监控,分级诊疗制度及信息披露机制等方面提供可行建议.
Drug-proportion regulation is on implementing following the price regulation and the elimination of markups on pharmaceuticals to curb the over-treatment,which is an important issue for Chinese healthcare reform.Based on that,we propose an evolutionary game model of doctor-patient behavior under drug-proportion regulation.Theoretically,it founds that there exists behavioral evolutionary law and stable strategies between physicians and patients according to replicator dynamics equation.Then treatment strategies are analyzed by considering normal treatment costs,the ratio of over-treatment to normal treatment costs,physician performance coefficient,and the severity of illness.The results show that drug-proportion regulation does not always inhibit over-treatment,which depends on a transition point.Physicians prefer to choose overtreatment while the drug-proportion is lower than the transition point.It is worth noting that the severity of illness affects over-treatment under the drug-proportion regulation.Physicians are prefer to over-treatment when patients are less ill.These conclusions are beneficial for drugproportion setting,light-illness monitoring,hierarchical diagnosis,and information disclosure mechanism.Finally,related healthcare policy suggestions are provided.
作者
吴晓丹
刘一凡
李娟
CHU Chao-Hsien
WU Xiaodan;LIU Yifan;LI Juan;CHU Chao-Hsien(School of Economics and Management,Hebei University of Technology,Tianjin 300401,China;College of Information Sciences and Technology,Pennsylvania State University,PA 16802,USA)
出处
《系统工程理论与实践》
EI
CSSCI
CSCD
北大核心
2019年第12期3163-3175,共13页
Systems Engineering-Theory & Practice
基金
国家社会科学基金(17BGL087)~~
关键词
演化博弈
医疗费用
过度医疗
药占比
evolutionary game
medical expenses
over-treatment
drug-proportion
