摘要
目的:用博弈理论来分析DRG病组定价时医方和保方的讨价还价行为。方法:通过分析DRG病组制定定额的基本流程、讨价还价的本质、构建并求解医方和保方讨价还价博弈模型,得到博弈模型的均衡解。结果:讨价还价模型对于先出价的医保方更有利,医院方为了增加自己的收益,可以选择在每一轮谈判上拖延时间或者增加谈判次数,以获得更多收益。结论:DRG病组定价时,信息不均衡和立场不一致是医方和保方博弈的主要原因,医保方具有先发优势,但医院方也具有反制措施。以成本核算为依据、提高信息的透明度、促进医疗市场的同质性、健全动态管理机制,可减少不必要的讨价还价博弈。
Objective:To analyze the bargaining behavior of doctors and insurers in pricing Diagnosis Related Groups(DRG)disease group with game theory.Methods:By analyzing the basic process of setting DRG quotas and the nature of bargaining in DRG,building and solving the bargaining game model between doctors and insurers,the equilibrium solution of the game model is obtained.Results:The bargaining model is more favorable for the first-bid insurer.In order to increase its income,the hospital can choose to delay the time in each round of negotiations or increase the number of negotiations to gain more benefits.Conclusion:When pricing DRG disease group,unbalanced information and inconsistent positions are the main reasons for the game between the medical side and the insurance side.The insurance side has the first-mover advantage,but the hospital sidc also has countermeasures.Taking cost accounting as the basis,improving the transparency of information,promoting the homogeneity of medical market and perfecting the dynamic management mechanism can reduce unnecessary bargaining games.
作者
方金鸣
陶红兵
FANG Jin-ming;TAO Hong-bing(Wuhan Fourth Hospital,Pu’ai Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430033,China;School of Medicine and Health Management,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430030,China;不详)
出处
《中国卫生经济》
北大核心
2021年第6期28-31,共4页
Chinese Health Economics
关键词
博弈论
按疾病诊断相关分组
医疗机构
医保
讨价还价
game theory
Diagnosis Related Groups
medical institutions
medical insurance
bargaining
