总额预付制下供需管三方协同发展策略研究  

Research on the coordinated development strategy of supply, demand and management under the total prepaid system

作　　者：仲之豪 王德文[2] 史健勇[1] 孔杨 姜茂敏 ZHONG Zhihao;WANG Dewen;SHI Jianyong;KONG Yang;JIANG Maomin(School of Management,Shanghai University of Engineering Science,Shanghai,201620,PRC)

机构地区：[1]上海工程技术大学管理学院,上海市201620 [2]厦门大学公共事务学院,福建省厦门市361005 [3]滨州医学院公共卫生与管理学院,山东省烟台市264003 [4]厦门大学公共事务学院公共管理系,山东省烟台市264003

出　　处：《中国医院》2022年第5期71-73,共3页Chinese Hospitals

基　　金：国家自然科学基金面上项目(72074187);国家社会科学基金一般项目(20BJY014);教育部哲学社会科学基金项目(19YJCZH072)。

摘　　要：目的:探究各利益主体在总额预付制度实施中出现的利益冲突,并探寻其最佳的解决方案,以期推动总额预付制在未来长期可持续发展。方法:依据利益相关者理论方法,描述总额预付制度在具体实施中出现的利益冲突主体,并通过冲突分析图模型,分析多方利益主体在总额预付制发展中的博弈均衡解,并求得最优的解决方案,以期预测未来冲突的事态发展趋势以及最终的结果。结果:通过实证模型,共获得256个状态点,经删除不可行状态和状态转移处理后执行稳定性分析,最终获得各个利益冲突主体均能接受的12个均衡解。结论:合理确定预算总额是优化总额预付制度的基础;精细化管理是实行总额预付制度的有效途径;以总额预付为主、多种支付方式并存的混合支付模式有利于促进医疗制度的改革;加强医保政策的宣传有利于总额预付制长期可持续发展。Objective:To explore the conflict of interests of various stakeholders in the implementation of the gross prepayment system,and to find the best solution,in order to promote the long-term sustainable development of the gross prepayment system in the future.Methods:According to the theory and method of stakeholders,describe the conflicting interests of the total payment system in the specific implementation,and through the conflict analysis graph model,analyze the game equilibrium solution of multi-stakeholders in the development of the total payment system,and obtain the optimal solution.solutions,with a view to predicting the development of future conflicts and their eventual outcomes.Results:Through the empirical model,a total of 256 state points were obtained,and the stability analysis was performed after deleting the infeasible state and state transition processing,and finally obtained 12 equilibrium solutions acceptable to all conflicting interests.Conclusion:Reasonable determination of the total budget is the basis for optimizing the total prepayment system;meticulous management is an effective way to implement the total prepayment system;the mixed payment model with total prepayment as the main and multiple payment methods coexisting is conducive to promoting the reform of the medical system;strengthening the The publicity of the medical insurance policy is conducive to the long-term sustainable development of the total prepayment system.

关 键 词：总额预付制度 医疗保险 冲突分析图模型 利益主体 

分 类 号：R197.3[医药卫生—卫生事业管理]