动态激励与最优医保支付方式

发布时间：2018-01-30 11:12

本文关键词： 医疗保险道德风险预付制重复博弈　出处：《经济研究》2017年11期 　论文类型：期刊论文

【摘要】：本文构建医院、患者、医保机构三方信息不对称条件下的重复博弈模型,研究了医保机构对医院的最优支付方式(最优价格管制)及其决定因素,研究发现:(1)无论医保机构实行预付制或后付制,为激励医院诚实诊疗,最优价格管制应保证医院获得正利润。(2)最优预付制价格可以得到显式解且形式简单,而有效规避医院道德风险的后付制价格组合则依赖于医保机构目标函数、患者收入分布的具体形式。(3)若患者自付比例足够低,则预付制优于后付制;若治疗成本随疾病严重程度变化足够大或医院不重视未来收益,则后付制优于预付制。模型解释了中国与发达国家医保支付方式改革中的几个标准化事实,并提示了我国当前实施医保预付制应注意的一些要点。
[Abstract]:This paper constructs the repeated game model under the condition of asymmetric information among hospital, patient and medical insurance organization, and studies the optimal payment method (optimal price control) and its determinants. The study found that: 1) regardless of whether the health care system is prepaid or post-paid, it is an incentive for hospitals to be honest in diagnosis and treatment. The optimal price control should guarantee the hospital to obtain positive profit. 2) the optimal prepaid price can get the explicit solution and the form is simple. But the post-payment price combination, which effectively avoids the moral hazard of the hospital, depends on the objective function of the medical insurance organization. The specific form of the patient's income distribution is: if the proportion of the patient's self-payment is low enough, the prepaid system is better than the post-payment system; If the cost of treatment varies sufficiently with the severity of the disease or the hospital does not attach importance to the future income, then the post-payment system is better than the prepaid system. The model explains several standardized facts in the reform of medical insurance payment methods in China and developed countries. It also points out some important points that should be paid attention to in the current implementation of medical insurance prepayment system in China.
【作者单位】：中国社会科学院经济研究所;
【基金】：国家社会科学基金项目“医保付费机制创新与公立医院改革研究”(14BGL145)资助
【分类号】：F842.684;R197.1
【正文快照】： 一、引言改革医保支付方式、发挥医保控费作用,是我国十三五期间建立更加公平更可持续社会保障制度的重要内容。2009年新医改以来,我国基本医疗保障覆盖面不断扩大,保障水平不断提高,基本建立全民医保制度,增进了人民福祉。但是医疗费用也随之快速上涨,远远高于物价水平增长

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