健康扶贫常态化转型的优化策略:基于核心利益相关者的博弈分析  

The Optimization Strategy of the Transformation of Health Poverty Alleviation:Analysis Based on the Game of Core Stakeholders

作　　者：贾清萍[1] 李丹 JIA Qing-ping;LI Dan(School of Public Administration,Nanchang University,Nanchang,330031,China;不详)

机构地区：[1]南昌大学公共管理学院,南昌330031

出　　处：《中国卫生经济》2020年第11期5-11,共7页Chinese Health Economics

基　　金：国家自然科学基金项目(71964024);江西省高校人文社会科学基金项目(GL18106)。

摘　　要：目的:探究健康扶贫向常态化转型的优化策略,为构建健康扶贫长效机制提供参考与建议。方法:基于当前健康扶贫的逐渐向常态化转型的时代背景、构建政府、医疗卫生机构与贫困户的博弈模型,模拟利益相关者博弈的演化路径、分析其稳定均衡状态以及影响纳什均衡实现的影响因素,并由此总结出健康扶贫常态化转型的优化策略。结果:政府的监管作为与医疗卫生机构的投机主义行为存在明显的相关性,影响着医疗卫生服务供给的价值效用;在信息不对称的环境下,医疗卫生机构的过度医疗容易造成贫困患者的逆向选择,导致医疗卫生领域出现"柠檬市场";地方政府的消极行为助长了医疗卫生机构和部分贫困户的道德风险,加重过度医疗与被动脱贫的现象。结论:为确保健康扶贫的可持续发展与常态化转型,必须从常态化治理理念、监督与约束机制、积极脱贫的意识与文化三条路径对健康扶贫进行完善和优化。Objective:To explore the optimization strategy for the transformation from health poverty alleviation to normalization,and to provide suggestions for the construction of long-term mechanism.Methods:Based on the current status of the implementation of the health poverty alleviation,it builds the game model of government,medical institutions,and the poor,to simulate the evolutionary path,analyze the stability of the equilibrium and the influencing factors of Nash equilibrium,and thus sums up the optimization strategy of health poverty alleviation normalized transformation.Results:There is an obvious correlation between government regulation and opportunism in medical and health institutions,which affects the value utility of medical and health service supply;in the context of information asymmetry,excessive medical treatment in medical and health institutions is likely to cause adverse selection of poor patients,leading to the emergence of the"lemon market"in the medical and health field;the negative behaviors of local governments have contributed to the moral hazard of medical and health institutions and some poor households,and aggravated the phenomenon of excessive medical treatment and passive poverty alleviation.Conclusion:To ensure the sustainable development and normalized transformation of the health poverty,it is necessary to improve and optimize the health poverty alleviation mechanism from three paths:developing normalized governance concept,construct supervision and restriction mechanism,nurturing active awareness and culture of poverty alleviation.

关 键 词：健康扶贫 利益相关者 博弈模型 演化均衡 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] R-012