摘要
设计合理医保支付方式,优化基层医疗资源配置,是实现"强基层"医疗改革,推进分级诊疗的重要措施.本文使用博弈模型,分析两家社区医院分别提供同质与异质医疗服务时,医患不签约、患者与单独医院签约、患者与医联体签约策略下社保机构、患者与社区医院的行为.研究发现,签约并不总是对医院和患者有利,也并不总能促进社区医院提高服务品质.两家医院提供同质医疗服务时,签约降低患者医疗费用支出,增加患者感知价值,但对医院提高服务品质无激励作用;两家医院提供异质医疗服务时,患者与单独医院签约降低两医院收益总和与所有患者服务价值总和,但患者与医联体签约增加医院与患者收益,更激励社区医院提高自身服务品质以增强竞争力.社区医院提供异质医疗服务,患者与医联体签约是一个社会最优策略.
Designing a reasonable medicare reimbursement method,and optimizing the resources distribution of primary care,are important ways to realize the "strong primary healthcare " reform and promote hierarchical diagnosis.We developed a game-theoretic model to analyze strategies when two primary care providers(PCPs) provide homogeneous or heterogeneous services,respectively.There are three strategies:not contract which is called baseline,patients contract with separate provider which is called strategy 1 and patients contract with medical treatment alliance which is called strategy 2.We found that contract is not always good for PCPs and patients.When the two PCPs provide homogeneous service,contract induces the medical cost decrease and the patients ’ perceived value increase.However,when the two PCPs provide heterogeneous service,the benefits of the PCPs and the patients decrease under strategy 1,but the opposite is true under strategy 2.Moreover,contract does not always encourage PCPs to improve service value.It has no incentive effect on PCPs with homogeneous service,but strategy 2 is a better motivator than strategy 1 with heterogeneous service.This is a socially optimal strategy.
作者
吴晓丹
张晓亚
岳殿民
CHU Chao-Hsien
WU Xiaodan;ZHANG Xiaoya;YUE Dianmin;CHU Chao-Hsien(School of Economics and Management,Hebei University of Technology,Tianjin 300401,China;College of Information Sciences and Technology,Pennsylvania State University,PA 16802,USA)
出处
《系统工程理论与实践》
EI
CSSCI
CSCD
北大核心
2021年第10期2548-2560,共13页
Systems Engineering-Theory & Practice
基金
河北省社会科学基金(HB16GL035)
河北省研究生创新资助项目(CXZZSS2020017)。
关键词
医疗保险
社区医院运营
医患签约
博弈论
medicare reimbursement
primary care providers(PCPs)
contract
game theory
