摘要
目的 探究在不同医保支付方式下不同医保利益主体之间的选择行为及其影响因素。方法 基于博弈理论,构建医院与医保机构、医院与患者之间在按项目付费和按DRGs付费两种支付方式下的博弈模型,分析博弈结果与博弈行为的影响因素,并由此提出医保支付方式方面的政策建议。结果 在医院与医保机构的博弈中,医院的诊疗策略主要受消极诊疗收入及其导致的惩罚影响,医保机构的行为主要受两种支付方式下不同的监管成本以及因此而产生的收入影响;在医院与患者的博弈中,需要尽量减少患者就诊成本,增加患者就诊时收益,同时减少患者因医院消极诊疗受到的损失。结论 医院应减少逐利行为,落实精细化管理措施;医保机构推行复合医保支付方式,加强监管;加强对患者的支付方式知识的普及工作,提升患者的健康意识。
Objective To explore the choice behavior and influencing factors of different medical insurance interest subjects under different medical insurance payment methods. Methods Based on the game theory, the game models between hospitals and medical insurance institutions, hospitals and patients under the two payment methods of fee-for-service and pay by DRGs were constructed, the influencing factors of game results and game behaviors were analyzed, and the policy suggestions on medical insurance payment methods were proposed accordingly. Results In the game between hospitals and medical insurance institutions, the diagnosis and treatment strategies of hospitals were mainly affected by the negative diagnosis and treatment income and the resulting penalty,while the behavior of medical insurance institutions was mainly affected by the different regulatory costs and the resulting income under the two payment methods. In the game between the hospital and the patient, it is necessary to reduce the cost of patient visit as far as possible, increase the benefit of patient visit, and reduce the loss of patients due to the negative diagnosis and treatment of the hospital. Conclusion Therefore, hospitals should reduce their profit-seeking behavior and implement refined management measures. Medical insurance institutions should promote the compound medical insurance payment methods, strengthen supervision;strengthen the popularization of the patients’ knowledge of the payment method, and improve the health awareness of patients.
作者
张婉莹
陶群山
魏骅
ZHANG Wanying;TAO Qunshan;WEI Hua(School of Economics and Management,Anhui University of Chinese Medicine,Hefei 230012,China)
出处
《广东药科大学学报》
CAS
2022年第6期115-120,共6页
Journal of Guangdong Pharmaceutical University
基金
安徽省哲学社会科学规划项目(AHSKY2021D23)。
关键词
博弈论
DRGS
医保支付方式
game theory
DRGs
medical insurance payment method
