| 引用本文：林坤河, 刘宵, 黄雨萌, 黄梅香, 钟正东, 李浩, 熊英贝, 周津, 项莉.区域点数法总额预算下医疗机构“冲点”行为分析——以DIP支付方式为例[J].中国卫生政策研究,2022,15(5):40-46 |
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| 区域点数法总额预算下医疗机构“冲点”行为分析——以DIP支付方式为例 |
| 投稿时间：2022-04-12 修订日期：2022-05-20 PDF全文浏览 HTML全文浏览 |
| 林坤河1, 刘宵1, 黄雨萌1, 黄梅香1, 钟正东1, 李浩1, 熊英贝1, 周津1, 项莉1,2 |
1. 华中科技大学同济医学院医药卫生管理学院 湖北武汉 430030;
2. 国家医疗保障研究院华科基地 湖北武汉 430030 |
| 摘要:区域点数法总额预算作为一种预算控制方式，可与不同的支付单元付费方式结合，探究区域点数法总额预算下医疗机构“冲点”行为，有助于改善医保支付方式运行模式。本研究对区域点数法总额预算下医疗机构“冲点”行为情况进行梳理，运用博弈论揭示DIP支付方式下医疗机构的“冲点”行为选择。从理论与实践方面均证明区域点数法总额预算会带来医疗机构“冲点”行为风险。通过博弈模型可知，DIP支付方式中医疗机构的严格优势策略包含不合理医疗的各类“冲点”行为。不合理“冲点”行为的惩罚金额、医保经办机构的监管成本、不合理“冲点”行为的额外收入金额大小对医疗机构不合理“冲点”行为和医保经办机构监管到位程度产生影响。医保部门需要从优化支付、监管机制等实施模式着手，减少不合理“冲点”行为。 |
| 关键词:DIP “冲点”行为 区域点数法总额预算 医保支付方式 |
| 基金项目:国家自然科学基金(71874058；72174068)；华中科技大学研究生创新基金(YCJJ202204018) |
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| Analysis on the “rush point” behavior of medical institutions under the total budget of regional point method: Take DIP payment method as an example |
| LIN Kun-he1, LIU Xiao1, HUANG Yu-meng1, HUANG Mei-xiang1, ZHONG Zheng-dong1, LI Hao1, XIONG Ying-bei1, ZHOU Jin1, XIANG Li1,2 |
1. School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science & Technology, Wuhan Hubei 430030, China;
2. HUST Base of National Institute of Healthcare Security, Wuhan Hubei 430030, China |
| Abstract:As a budget control method, the regional point method total budget can be combined with different payment unit payment methods, and it is helpful to explore the “rush point” behavior of medical institutions under the regional point method total budget to improve the operation mode of medical insurance payment methods. This study collected the “rush point” behavior of medical institutions under the total budget of the regional point method, and used game theory to reveal the “rush point” behavior choice of medical institutions under the dip payment method. Both theory and practice have proved that the total budget of regional point method will bring about the risk of “rush point” behavior of medical institutions. The game model showed that the strict advantage strategy of medical institutions in the DIP payment method was to include unreasonable medical “rush point”. The amount of penalty for unreasonable “rush point” behavior, the cost of supervision by the medical insurance agency, and the amount of extra income from unreasonable “rush point” behavior affected the amount of unreasonable “rush point” behavior of medical institutions and the degree of supervision by the medical insurance agency. The amount of penalties for “rush point” and the cost of supervision by the health insurance agency had an impact on the extent of supervision by the health insurance agency. The medical insurance department needs to start optimizing the implementation mode of payment and supervision mechanism to reduce unreasonable “rush point” behavior. |
| Key words:DIP “Rush point” behavior Total budget of regional point method Medical insurance payment method |
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