DRG支付制度下医疗资源消耗和医保定额设置的博弈研究  

Game Study on Medical Resource Consumption and Medical Insurance Expense Setting under DRG Payment System

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 Technology,Wuhan,430033,China;School of Medical and Health Management,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430030,China)

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5期21-24,共4页Chinese Health Economics

摘　　要：目的:用DRG定价原理和博弈理论分析医疗资源消耗和医保定额设置的博弈策略和结果。方法:通过DRG定价原理、医方和保方的博弈行为分析,构建并求解医疗资源消耗和医保定额设置的博弈模型,并得到重复博弈的均衡解。结果:在DRG制度下,医方医疗资源消耗和保方医保定额设置的博弈结果是,医方选择缩减医疗,保方选择下调额度。该博弈反复进行,最终的均衡结果是医方将医疗价格缩减到较低的状态,形成了医疗价格的逆向选择。结论:DRG支付制度下,要正确认识病组定额下降的必然性和医方开展正面和负面的缩减医疗的可能性。通过加强医疗行为监督、行政调整病组定价、建立成本核算体系,来防止医疗质量的逆向选择。Objective:Using DRG pricing principle and game theory to analyze the game strategy and results of medical resource consumption and medical insurance expense setting.Methods:According to the pricing principle of DRG and the game behavior between doctors and insurers,the game models of medical resource consumption and medical insurance expense setting were constructed and solved,and the equilibrium solution of repeated game was obtained.Results:Under the DRG system,the result of the game between the consumption of medical resources of doctors and the medical insurance expense setting of insurers is that doctors choose to reduce medical care while insurers choose to reduce the expense.As the game repeated,the final equilibrium result is that the doctor reduces the medical price to the lowest state,which forms the adverse selection of medical price.Conclusion:Under the DRG payment system,it is necessary to understand the inevitability of the reduction of the expense of the disease group and the possibility of the doctors to carry out positive and negative reduction of medical care.To prevent the adverse selection of medical quality,it needed to strengthen the supervision of medical behavior,adjust the pricing strategy by administration and establish a cost accounting system.

关 键 词：疾病诊断相关分组 医疗资源 医保定额 博弈论 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] R19-0