摘要
随着精准扶贫战略的全面推进,到2020年现行标准下的贫困人口将全部脱贫.但现有贫困问题的解决并不代表从此之后再不会出现贫困人口.而基本医保,大病保险和医疗救助是防止出现贫困人口的重要保障,通过构建医疗费用的三方分担体系,分担一部分可能仍需要额外报销的费用,是保证不再出现因病致贫,因病返贫人口的重要基础.本文考虑了医保额外报销费用的分担问题,引入供应链和博弈论的思想,将该问题转化为一个多方分担费用的问题.首先,构建了一个费用分担模型,为了简化各方分担比例的计算,假设由基本医疗保险承担全部的额外报销费用,大病保险和医疗救助通过承担前者的基本报销费用达到分担额外报销费用的目的.然后,由两个纳什均衡的讨价还价模型组成整个协商过程.根据三方的协商结果解决各方冲突和费用分担问题,并得到最终费用分担比例的优化决策.最后,通过对其分担结果进行数值分析得到随着承担的额外费用越多,大病保险和医疗救助承担的基本费用更多,并且通过数据模拟证明模型的有效性和正确性.
With the implementation of the policy of targeted poverty alleviation,the impoverished people under the current standards by 2020 will all be lifted out of poverty.Nevertheless,the solution to the existing problem of impoverished people does not mean that there will be no more impoverished people after that.Basic medical insurance,critical illness insurance program and medical assistance are important guarantees to prevent the emergence of impoverished people.The establishment of a tripartite system of sharing medical expenses,which may still require additional reimbursement,is an important basis for ensuring that there is no more impoverished by diseases and back to poverty due to illness.In this paper,we consider the problem of sharing additional expenses of medical insurance,introduce the theory of supply chain and game theory,and transform the problem into a multi-party cost-sharing problem.Firstly,we have constructed a cost-sharing model,to simplify the calculation of the proportions of parties,assume in which the basic medical insurance covers all the additional expenses,and critical illness insurance program and medical assistance achieve the purpose of sharing the additional reimbursement expenses by assuming the basic reimbursement expenses of the former.Then,the contract-bargaining process is composed of two Nash bargaining models.The problem of conflict and cost sharing is resolved according to the result of tripartite consultation,and the optimal decision of final cost sharing ratio is obtained.Finally,through the mathematical analysis of above-mentioned results,the more additional costs are borne,the more the basic costs are borne by critical illness insurance program and medical assistance,and the validity and correctness of the model are proved by data simulation.
作者
赵可彤
孙秉珍
宋兆宇
ZHAO Ketong;SUN Bingzhen;SONG Zhaoyu(School of Economics&Management,Xidian University,Xi'an 710071,China)
出处
《系统工程理论与实践》
EI
CSSCI
CSCD
北大核心
2021年第1期134-146,共13页
Systems Engineering-Theory & Practice
基金
国家自然科学基金面上项目(71571090)
陕西省高校青年创新团队
中央高校基本科研业务费项目(JB190601)
西安电子科技大学经济与管理学院研究生创新实践种子基金。
关键词
贫困人口
医保报销比例
费用分担模型
纳什均衡
优化决策
impoverished people
medical insurance reimbursement ratio
cost sharing model
Nash bargaining
optimization decision
