基于博弈理论的DRG支付制度下医院和医生层面诊疗行为分析  

Analysis of Diagnosis and Treatment Behavior at Hospital and Doctor Level under DRG Payment System Based on Game Theory

作　　者：方金鸣 陶红兵[2] FANG Jin-ming;TAO Hong-bing(Wuhan Fourth Hospital,Pu’ai Hospital,Tongji Medical College,Huazhong University of Science and Technolog,Wuhan,430033,China;School of Medicine and Health Management,Wuhan,430030,China;不详)

机构地区：[1]武汉市第四医院华中科技大学同济医学院附属普爱医院,武汉430033 [2]华中科技大学同济医学院医药卫生管理学院,武汉430030

出　　处：《中国卫生经济》2021年第3期9-13,共5页Chinese Health Economics

摘　　要：目的:用博弈理论分析DRG支付制度下医院和医生层面诊疗行为的不同方法:通过理论分析DRG支付制度下医疗机构收入的费用结构和医生收入的费用结构,构建并求解医疗机构和医生的诊疗行为的博弈模型,得到博弈模型的均衡解。结果:在DRG支付下,医疗机构会从过度医疗向缩减医疗的行为转变,但在有药企激励时,医生可能执行过度医疗策略,也可能执行缩减医疗策略,在目前的绩效考核条件下,医生更容易执行缩减医疗策略。结论:DRG支付制度下,医院层面会率先与医保的支付目标达到一致,医生层面的医疗行为不一定与医保的支付目标一致,必须通过减少药企对医生的激励作用,提升医院对医生的绩效分配比例、增大医院成本和患者自付比例的差值、提高医保部门的治理能力等方法,才能破解医院和医生的激励不相容。Objective:To analyze the differences of diagnosis behavior between hospitals and doctors under DRG payment system with game theory.Methods:Through theoretical analysis of the cost structure of medical institution income and doctor income under DRG payment system,the game model of medical institution and doctor’s diagnosis behavior was constructed and solved,and the equilibrium solution of the game model was obtained.Results:Under DRG payment,medical institutions will transfer from over-medical treatment to reduced medical treatment.However,when doctors are encouraged by pharmaceutical companies,they may implement over-medical treatment strategy or reduced medical treatment strategy.Under the current performance appraisal conditions,doctors are more likely to implement reduced medical treatment strategy.Conclusion:Under the DRG payment system,the hospital level will take the lead in meeting the payment goal of medical insurance,while the medical behavior at the doctor level may not be consistent with the payment goal of medical insurance.By reducing the incentive effects of pharmaceutical companies on doctors,improving the performance distribution ratio of hospitals to doctors,increasing the difference between hospital cost ratio and patients’out-of-pocket ratio,and improving the governance ability of medical insurance departments,it could solve the incentive incompatibility between hospitals and doctors.

关 键 词：疾病诊断相关分组 支付制度 医疗机构 医生行为 博弈论 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] R19-0