基于双边垄断模型的医疗服务医保支付标准研究  

The Research about the Price of Medical Insurance Payment for Health Services based on Bilateral Monopoly Model

作　　者：倪沪平 

机构地区：[1]浙江大学公共管理学院,杭州310058

出　　处：《中国医疗保险》2017年第11期20-23,29,共5页China Health Insurance

基　　金：国家社会科学基金重大项目<人口老龄化与长寿风险管理的理论和政策研究>(项目批准号:13&ZD163)的阶段性研究成果

摘　　要：医保部门与医院部门通过谈判,形成医疗服务医保支付标准,是未来中国医改的发展趋势。医疗服务医保支付标准机制可分为医院部门占优、医保部门占优、医院和医保部门势均三种双边垄断市场结构进行研究。从双边垄断模型看,医疗服务医保支付标准在医院部门占优情况下最高,而在医保部门占优情况下最低。过低或过高的医疗服务医保支付标准,都将不利于医院发展和参保人员福祉。医保部门和医院部门可以通过合作,最终形成协议价格,实现医疗服务社会福利最优。通过仿真模拟,揭示医疗服务医保支付标准、医疗服务数量、医保部门和医院部门收益相对于单位医疗保险费、医疗资本和医生劳动投入、医院资本折旧、医生工资标准、医院资产投入和高端医疗设备更新速度等参数的变化规律。It is the future development trend of China＇s medical reform that medical insurance sector and hospital sector be through negotiations for forming the price of medical insurance payment for health services. The research about the medicare payment’s price mechanism can be divided into three kinds of bilateral monopoly market structure, the hospital sector dominated, the medical insurance sector dominated, the hospital and medical insurance sector evenly matched. Based on analysis of bilateral monopoly model, medicare pay the highest price of medical services in the situation of hospital sector dominated, the paid price being minimum in the situation of the health care sector dominated. Excessively low or high prices paid by medicare medical services, be not conducive to the development of the hospital and the insured bene？ ts. The health insurance sector and hospital sector can cooperate to form the agreed price, ？ nally, achieving the best health care social welfare.Through simulation, we reveal the change’s law about the price of medical services, the quantity of medical services, and the gains of the health care sector and the hospital sector, with respect to the parameters about the unit medical insurance, medical capital and doctors’ labor inputs, hospital’s capital depreciation, doctors’ wage, hospital’s asset investment, the renewal rate of the high-end medical equipment.

关 键 词：医疗服务 医疗保险 支付价格 双边垄断 

分 类 号：F842.684[经济管理—保险] R197.1[医药卫生—卫生事业管理]