DRG点数法下医疗机构服务量的博弈研究——基于博弈理论和实证分析  

Game study on quantity of services of medical institutions under DRGs point payment-Based on game theory and empirical analysis

作　　者：方金鸣 陶红兵[2] FANG Jinming;TAO Hongbing(Wuhan Fourth Hospital,Wuhan Hubei 430033,China;School of Medicine and Health Management,Tongji Medical College,Huazhong University of Science and Technology,Wuhan Hubei 430030,China)

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

出　　处：《卫生软科学》2023年第5期5-8,共4页Soft Science of Health

摘　　要：[目的]用博弈理论和实证数据分析DRG点数法对医疗机构之间诊疗服务量的影响。[方法]通过理论分析DRG点数法的原理,构建并求解医疗机构服务量的数学模型,得到模型的均衡解。通过实证数据,验证模型的结果。[结果]在DRG点数法下,医疗机构增加点数的行为使得点数的平均价值下降,但可以增加自身的收益。同时,为避免其他机构增加点数对自己的负效应,医疗机构增加自身点数的行为不可避免,最终导致纳什均衡下的医疗机构诊疗总服务量大于全区域最优的病人服务量。实证数据也发现,18个点数法病组的患者人次数存在增多。[结论]DRG点数法导致医疗机构冲点行为,并导致全局整体利益降低,使医疗机构承担了大部分风险。Objective To analyze the influence of DRGs point payment on quantity of services of medical institutions by game theory and empirical data analysis.Methods Mathematical model of quantity of services of medical institutions was constructed and solved by theoretically analyzing principles of DRGs point payment,and the equilibrium solution of the model was obtained.Through empirical data,the Results of the model were verified.Results Under DRGs point payment,medical institutions reduced the average value of points by increasing the number of points,which increased their own returns.At the same time,the medical institutions were inevitable to increase their own points in order to avoid the negative effect of increasing points in other institutions.Finally,total services of medical institutions under Nash equilibrium were greater than the optimal quantity of services for patients in the whole region.Empirical data also found that the number of patients in 18 disease groups increased.Conclusions DRGs point payment leads to increasing points in medical institutions,which leads to the reduction of overall interests and makes medical institutions bear most of the risks.It can promote the efficiency of medical security funds and share the risks of medical insurance funds by strengthening administrative intervention,innovating rules of point payment,and establishing a negotiation mechanism between hospitals and healthcare security administration.

关 键 词：博弈论 DRG 点数法 医疗机构 

分 类 号：R197[医药卫生—卫生事业管理]