共同代理下我国公立医院补偿标准分析与博弈——以消费者均衡为视角  

Compensation Standard and Game of Public Hospitals in China Under Common Agency——From the Perspective of Consumer Equilibrium

作　　者：陈振生 徐兵 甘筱青 CHEN Zhen-sheng;XU Bing;GAN Xiao-qing(School of Management,Nanchang University, Nanchang 330031 , China;Jiujiang University,Jiujiang 332005,China)

机构地区：[1]南昌大学管理学院,江西南昌330031 [2]九江学院,江西九江332005

出　　处：《系统工程》2019年第3期78-85,共8页Systems Engineering

基　　金：国家自然科学基金资助项目(71663034;71561018);江西省政府研究生创新项目(YC2017-S049)

摘　　要：本文在共同代理条件下,构建了以公立医院为共同代理人,政府、患者和医保机构为委托人的两阶段动态博弈模型,以消费者均衡为视角对公立医院的补偿标准进行分析,并对比了在非合作情形下与合作情形下的激励效率。研究发现:起付线与自付比的高低取决于患者的患病情况,对于疑难重症应设"高"起付线,"低"自付比,而对于常见病、多发病应设"低"起付线,"高"自付比;患病情况给定,为了维持消费者均衡,降低起付线的同时必须提高自付比,反之亦然。如患者的边际效用非常高,起付线与自付比对患者就医的引导作用失效;财政补助不足是导致"看病难、看病贵"问题的主要原因;建立了医疗服务的价格标准和财政补助的最低标准;与非合作博弈相比,合作博弈同时存在提高效率和降低效率两个力的作用,总效率是提高或降低,取决于两个力的相对大小。In order to improve the compensation mechanism of public hospitals,this paper constructs a two-stage dynamic game model with public hospitals as common agent,governments,patients and medical insurance institutions as a mutually independent principals under common agency,analyzing the compensation mechanism of public hospitals from the perspective of consumer equilibrium,and compares the incentive efficiency under non-cooperative with that under cooperative situations.The study found that:It was found that the level of deductible and individual payment proportion depended on the patient’s condition.For the difficult and severe cases,the deductible should be"higher"and the individual payment proportion should be"lower"than for common and frequently-occurring diseases.If the condition of illness is given,the deductible must be lowered while the individual payment proportion is increased,and vice versa.However,when patients’marginal utility is very high,the deductible and the individual payment proportion fail to guide patients to seek medical treatment;insufficient financial subsidy is the main reason for the problem of"difficult and expensive medical treatment";the price standard of medical services and the lowest standard of financial subsidy are established;Compared with non-cooperative game,cooperative game has the dual effects of improving and reducing efficiency.Whether comprehensive efficiency is reduced or improved depends on the relative size of the two forces.

关 键 词：共同代理 公立医院 博弈分析 起付线与自付比 财政补助 

分 类 号：R197[医药卫生—卫生事业管理]