由后付制向预付制转变对医生行为影响的实验研究  

The Experimental Research on the Influence of the Transform from Retrospective Reimbursement to Prospective Reimbursement on Physicians’Behaviour

作　　者：张馨元 韩优莉[1] 薄云鹊 戚淼杰 李星 ZHANG Xin-yuan;HAN You-li;BO Yun-que(School of Public Health,Capital Medical University,Beijing,100069,China)

机构地区：[1]首都医科大学公共卫生学院,北京100069

出　　处：《中国卫生经济》2020年第4期28-32,共5页Chinese Health Economics

基　　金：国家自然科学基金项目(7177030267)。

摘　　要：目的:利用经济学实验探究按服务项目付费(FFS)和按疾病诊断相关分组付费(DRG)的激励对医生医疗服务供给行为的影响。方法:利用z-tree软件编程,招募120名临床相关专业的高年级本科生和研究生作为被试,测试其在FFS与DRG下为不同健康状况的患者选择提供的医疗服务数量。结果:总体上受试者在FFS(DRG)下提供的平均医疗服务量高(低)于最优服务量,差异有统计学意义。FFS下,受试者为健康状况好和中等的患者提供的平均医疗服务量分别为5.14、6.15,均高于最优服务量,在DRG下,受试者为健康状况好、中等、差的患者提供的平均医疗服务量分别比最优服务量少2.15%、10.73%、23.40%,差异有统计学意义。结论:FFS激励医生提供过量的医疗服务,DRG激励医生提供不足的医疗服务。FFS下医生对处于好和中等健康状况的患者过度服务,而DRG供给不足的程度随着患者疾病严重程度的增加而增加,且DRG下医生为健康状况好的患者提供的医疗服务量对患者最有利且医生所损失的净收益最少,对于健康状况中等和差的患者则相反。Objective:It introduces a laboratory experiment to analyze the influence of incentives from fee-for-service(FFS)and diagnosis-related groups(DRG)payments on physicians’supply of medical services.Methods:Using z-tree software programming,and it recruites 120 senior undergraduate and graduate students from clinically relevant majors as subjects to test the quantities of medical services provided for patients with different states of health under FFS and DRG.Results:In general,the average quantities of medical services provided by subjects under FFS(DRG)were higher(lower)than optimal quantities,the difference was statistically significant.Under FFS,the average quantities of medical service provided for patients with good and intermediate health status are 5.14 and 6.15 respectively,which are higher than optimal quantities.Under DRG,the average quantities of medical services provided for patients with good,intermediate and bad health status are 2.15%,10.73%and 23.40%less than optimal quantities,the difference was statistically significant.Conclusion:It finds out that patients are overserved under FFS and underserved under DRG.physicians in FFS overserve patients in a good and intermediate state of health.As the severity of patient’s disease increases,physicians underserve in DRG to a higher degree and the quantities of medical services provided by physicians in DRG for patients with good health status is most beneficial to patients and the net profit loss of physicians is the least,which is the opposite in FFS.

关 键 词：医保支付方式 按服务项目付费 按疾病诊断相关分组付费 医生行为 实验经济学 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] F840.613[经济管理—保险]