基于博弈论的医保支付方式最优选择研究  

Research on Optimal Choice of Medical Insurance Payment Methods Based on Game Theory

作　　者：贾琼 许丰[2] 吴海波[1] Jia Qiong(School of Economics and Management,Jiangxi University of Traditional Chinese Medicine,Nanchang,330004)

机构地区：[1]江西中医药大学经济与管理学院,南昌330004 [2]南方医科大学南方医院,广州510515

出　　处：《医学与社会》2020年第2期112-116,共5页Medicine and Society

基　　金：江西省教育科学规划重点项目,编号为18ZD052。

摘　　要：目的:在分析预付制、后付制和混合制各自优缺点的基础上,研究相对最优的医保支付方式。方法:通过构建“医疗机构-患者-医保机构”三方动态博弈模型,探究在信息不对称条件下医疗服务供方对3种医保支付方式的博弈策略选择。结果:预付制虽能有效控制医疗费用,但易导致医疗机构采取“诊疗不足”策略;后付制虽能保障医疗服务质量,但易导致医疗机构采取“过度诊疗”策略;相比较而言,混合制既能有效控制医疗费用,又能保障医疗服务质量,激励医疗机构采取“诚实诊疗”策略,是医保支付方式的最优选择。结论:推广并完善以预付制为主的混合支付方式有利于保障参保人员的基本医疗权益和医保制度的长期可持续发展。Objective:To explore the optimal medical insurance payment method based on analyzing the advantages and disadvantages of prepayment system,post payment system and mixed payment system.Methods:By constructing the three-party dynamic game model of“medical institutions-patients-social health insurance institution”,this paper focused on the game strategy choice of medical service providers to three types of medical insurance payment methods under the condition of information asymmetry.Results:Although the prepayment system could effectively control the medical expenses,it was easy for medical institutions to adopt the"insufficient diagnosis and treatment"strategy.Although the post payment system could guarantee the quality of medical services,it was easy for medical institutions to adopt the"excessive diagnosis and treatment"strategy.In comparison,the mixed payment system could not only effectively control medical expenses,but also guarantee the quality of medical services,and encourage medical institutions to adopt the"honest diagnosis and treatment"strategy,which was the best choice for medical insurance payment methods.Conclusion:Promoting and completing the mixed payment method based on the prepayment system is conducive to ensuring the basic medical rights and interests of the insured and the long-term sustainable development of the medical insurance system.

关 键 词：医保支付方式 预付制 后付制 混合制 博弈模型 

分 类 号：R197.1[医药卫生—卫生事业管理]