| 引用本文：林坤河, 刘宵, 熊英贝, 姚轶凡, 项莉.DIP支付方式与紧密型医共体总额付费政策融合研究[J].中国卫生政策研究,2023,16(4):18-24 |
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| DIP支付方式与紧密型医共体总额付费政策融合研究 |
| 投稿时间：2022-12-27 修订日期：2023-02-28 PDF全文浏览 HTML全文浏览 |
| 林坤河1, 刘宵1, 熊英贝1, 姚轶凡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:在DIP的政策框架范围内，探索DIP支付方式与紧密型医共体总额付费政策融合模式，分析各模式对医共体服务行为影响。本研究应用博弈论从政府和医共体、医共体和医疗机构双层经济激励结构，即外部支付方式和内部分配模式两个层面，构建医共体打包付费三个组合模式下的博弈模型。研究发现，当DIP支付方式既用于外部支付，又用于内部分配时，扩大服务量为最优策略，容易导致医共体内外竞争；当只用于外部支付，不用于内部分配，仍持续对外进行服务扩张，内部分配制度的设计空间不足；当不用于外部支付，只用于内部分配时，有助于通过按人头总额付费削弱医共体对外的无序竞争，同时通过DIP支付规则，应用区域内不同点值规范医疗机构恶意扩大服务量的不合理行为。 |
| 关键词:DIP 医保支付方式 总额付费 紧密型医共体 |
| 基金项目:国家自然科学基金(72174068；71874058)；首都医科大学国家医保研究院开放性课题(YB2022B08) |
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| A study on the integration of DIP payment method and the total payment policy of close-knit medical community |
| LIN Kun-he1, LIU Xiao1, XIONG Ying-bei1, YAO Yi-fan1, XIANG Li1,2 |
1. School of Medicine Health Management of Tongji Medical College of Huazhong University of Science and Technology, Wuhan Hubei 430030, China;
2. HUST base of National Institute of healthcare Security, Wuhan Hubei 430030, China |
| Abstract:Within the policy framework of DIP, explore the integration mode of DIP payment method and the total payment policy of close-knit medical community, and analyze the impact of each mode on the service behavior of medical community. Game theory is applied to build game models under three combination modes of medical community package payment from the two-layer economic incentive structure of government and the close-knit medical community, the close-knit medical community and medical institutions, namely, external payment mode and internal distribution mode. It is found that when DIP payment is used for both external payment and internal distribution, expanding service volume is the optimal strategy, which tends to lead to internal and external competition in the medical community. When it is only used for external payment, not for internal distribution, the design space of the internal distribution system is insufficient when it continues to expand its service externally.. When it is not used for external payment but only for internal distribution, it is helpful to weaken the disorderly competition outside the medical community by paying per capitation amount. At the same time, through DIP payment rules, different point values in the region are applied to regulate the unreasonable behavior of medical institutions maliciously expanding the service volume. |
| Key words:DIP Payment method of medical insurance Total budget payment Close-knit medical community |
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