摘要
目的:研究在完全信息和不完全信息两种情况下,政府应用医保补助和诊疗能力规制对分级诊疗的影响效应。方法:根据研究目标假设政府和医院的目标函数,构建两级博弈模型。首先由政府确定医保补助水平或者确定医疗服务能力水平,然后医院确定诊疗服务量,政策规制对医院诊疗服务量变化的影响程度用来表征分级诊疗效应。结果:以完全信息情况作为比较基准,在信息不对称情况下,低诊疗范围医院所获得的医保补助和诊疗服务量会相对下降。如果政府利用医保资金补助差进行分级诊疗调控,同时配套对不同级别医院诊疗能力进行规制,不考虑公共资金成本,定量测算分级诊疗效果会提高1.5倍。结论:在医疗服务能力约束下,医保补助下降有助于减少医疗诱导需求,其效应取决于诊疗服务量对医保补助的边际量水平。如果政府同时利用医保补助和诊疗能力规制两种政策工具进行调控,随着公共资金成本的上升,分级诊疗效果会减弱。
Objective:To study the influence of the government’s application of medical insurance subsidy and treatment capacity regulation on the hierarchical diagnosis under the conditions of complete and incomplete information.Methods:According to the research objective,it assumes the objective function of the government and the hospital to construct a two-stage model.The government determines the level of medical insurance subsidy or the level of medical service capacity,and the amount of treatment services.The impact of regulation on the change of hospital treatment service is used to characterize the effects of hierarchical diagnosis.Results:As the benchmark of the condition of complete information,in the case of asymmetric information,the amount of medical insurance and the number of patients treated in hospitals with a low disease severity will be relatively decreased-If the government uses the medical insurance subsidy and the hospital treatment ability regulation to regulate the hierarchical diagnosis,without considering the cost of public funds,the effect will be increased by 1.5 times.Conclusion:Under the constraint of medical service capacity,the decrease of medical insurance subsidy helps to reduce the demand for medical inducement,and its effect depends on the marginal level of medical service to medical insurance subsidy.If medical insurance subsidy and medical service capacity both are applied to regulation,the effect of tiered medical services will be worse as the cost of capital is high.
作者
张平
吴登丰
ZHANG Ping;WU Deng-feng(School of Economics and Management,Jiujiang University,Jiujiang,Jiangxi,332005,China;不详)
出处
《中国卫生经济》
北大核心
2020年第10期19-24,共6页
Chinese Health Economics
基金
国家自然科学基金资助项目(71661018)
江西省科技厅软科学项目(20161BBA10031)。
关键词
政策规制
医院选择
分级诊疗
动态博弈
government regulation
hospital behavior
hierarchical diagnosis
dynamic game
