基于实验经济学的APG支付对医生医疗行为的影响研究  

The effect of APG payment on doctors medical behavior based on experimental economics

作　　者：谭清立 凌姝睿 TAN Qing-li;LING Shu-rui(School of Medical Business,Guangdong Pharmaceutical University,Zhongshan Guangdong 528400,China;Guangdong Health Economics and Health Promotion Research Center,Guangzhou Guangdong 510006,China)

机构地区：[1]广东药科大学医药商学院,广东中山528400 [2]广东药科大学卫生经济与健康促进研究中心,广东广州510006

出　　处：《中国卫生政策研究》2024年第9期22-27,共6页Chinese Journal of Health Policy

基　　金：广东省软科学研究计划项目(2024A1010030012);2024年度广东省哲学社会科学规划一般项目(GD24CGL29);广州市哲学社会科学发展“十四五”规划2023年度一般课题(2023GZYB68)。

摘　　要：通过实验经济学方法收集临床相关专业毕业生和研究生的调查问卷,以医学生在按服务项目付费(FFS)和门诊病例分组(APG)支付两种医疗保险支付方式下为不同健康状况和疾病类型的患者提供医疗服务数量的决策模拟,讨论不同支付模式对医生提供医疗服务的影响。结果表明,医生在两种不同支付模式下为不同健康状态和疾病类型患者提供的医疗服务数量均存在显著差异。医生受到FFS模式的激励,往往会为患者提供过多的医疗服务,而APG可以制约医生提供过量医疗服务,医生在APG模式下作出的最优医疗服务决策数量也显著多于FFS模式。而相较于APG,FFS模式能够更好地保障健康状况较差、病情复杂的病例的医疗需求,并提供更全面的医疗服务。建议对常规门诊和常见病例尽量采用APG支付模式,对于情况复杂、严重的病例推进FFS支付作为补充支付方式。This paper collects questionnaires from graduates and graduate students of clinical-related majors through economic experiments,and discusses the impact of different payment modes on the quantity and quality of medical services provided by doctors by simulating the decision of medical students to provide medical and health services to patients with different health conditions and disease types under two medical insurance payment methods:Fee-for-service(FFS)and Ambulatory Patient Groups(APG).The results showed that there were significant differences in the number of health services provided by doctors to patients with different health conditions and patients with different disease types under two different payment models.Physicians are motivated by the FFS model to provide too many medical and health services to patients,and APG can restrain doctors from providing excessive medical services,and the number of optimal health care service decisions made by doctors in the APG model is significantly higher than that of the FFS model.Compared with APG,the FFS model can better protect the medical needs of cases with poor health and complex conditions,and provide more comprehensive medical and health services.Finally,the paper puts forward suggestions such as using the APG payment mode as much as possible for routine outpatient clinics and common cases,and promoting FFS payment as a supplementary payment method for complex and severe cases.

关 键 词：医保支付方式改革 门诊病例分组 按项目付费 医疗行为 

分 类 号：R197[医药卫生—卫生事业管理]