基于演化博弈模型的老年人医保多主体利益交互关系及策略选择分析  

Analysis of Multi-body Interest Interaction and Strategy Selection of Elderly People’s Medical Security Based on the Evolutionary Game Model

作　　者：陶晓萌 曾雁冰 Tao Xiaomeng;Zeng Yanbing(School of Public Health,Capital Medical University,Beijing,100069,China;不详)

机构地区：[1]首都医科大学公共卫生学院,北京100069

出　　处：《中国医院管理》2024年第11期30-35,共6页Chinese Hospital Management

基　　金：国家自然科学基金项目(71874147);教育部人文社会科学研究一般项目(23YJAZH010);北京市社会科学基金项目(22JCB038)。

摘　　要：目的明确我国老年人医保多主体的利益交互关系及策略选择,为老年人医保政策的完善提供决策依据。方法基于演化博弈理论构建医保方、医疗服务提供方与老年参保人三方演化博弈模型,并采用Matlab R2021b软件对其稳定状态进行模拟仿真。结果当三方主体均考虑自身效用最大化时,医保方、医疗服务提供方与老年参保人三方存在利益冲突。为达到演化均衡状态,医保方的策略选择为采取“节流”行为控制医保费用支出,老年参保人选择增加医疗服务利用满足医疗服务需求,医疗服务提供方的策略选择则与医保报销比例和医疗服务成本比例的数量关系有关。当医保报销比例p为0.95时,医疗服务提供方理性行为的概率最大。结论报销比例较高的医疗服务提供方选择理性行为的概率较大,同时也不能盲目提升医保报销比例。建议合理调整医保待遇水平,健全医保报销比例差异化建设,同时完善医疗行为监管措施,在有效满足老年人群健康需求的同时,保障医疗安全。Objective To clarify the interaction among the interests and strategic choices of multiple subjects of medical insurance for the older people in China,and to provide a decision-making basis for the improvement of medical insurance policy for the older people.Methods An evolutionary game model was constructed based on evolutionary game theory and its steady state was simulated using Matlab R2021b software for the health insurer,the health care provider and the elderly.Results There is a conflict of interest between health insurance providers,healthcare providers and older people when all three parties consider maximising their own utility.In order to reach an evolutionary equilibrium,the strategic choice of the health insurance provider is to take“cost-cutting”behaviour to control the expenditure of the health insurance fund;the strategic choice of the older people is to increase the use of medical services to meet the demand for medical services;and the strategic choice of the medical service provider is related to the quantitative relationship between the reimbursement ratio of the health insurance and the cost ratio of medical services.When the reimbursement rate is 0.95,the probability that the provider will choose rational behaviour to control health care expenditure is the highest.Conclusion Healthcare providers with higher reimbursement rates have a higher probability of choosing rational behaviour.At the same time,the medical insurance reimbursement ratio cannot be raised blindly.It is recommended that the level of health insurance benefits be reasonably adjusted,the construction of a differentiation of the reimbursement ratio of medical insurance should be improved,and the measures for the management of medical behaviors should be enhanced,so as to effectively meet the health needs of the elderly population while at the same time guaranteeing medical safety.

关 键 词：演化博弈模型 老年人 医保 利益交互关系 策略选择 

分 类 号：R197[医药卫生—卫生事业管理]