一个创新的基于案例的支付计划是否促进了等级医疗体系? 一个三方进化游戏分析
Huanyu Shi1, Zhichao Cheng2, Zhuang Cao3
1School of Economics and Management, Beihang University, Beijing, 100191, China. hyshi@buaa.edu.cn.
中国的诊断干预计划 (DIP) 支付改革可以促进层次医疗体系 (HMS). 关键因素包括政府的激励措施,患者对初级保健质量的看法,以及对HMS的机构支持.
科学领域:
- 卫生经济学 卫生经济学
- 卫生政策分析 卫生政策分析
- 游戏理论在医疗保健中的应用.
背景情况:
- 中国旨在通过等级医疗体系 (HMS) 提高卫生资源效率和公平性.
- 创新的诊断干预套餐 (DIP) 支付计划正在全国范围内试点实施.
- 关于DIP对促进HMS的影响的证据有限.
研究的目的:
- 分析DIP支付改革对中国HMS实施的影响.
- 模拟地方政府,高级医疗机构和DIP下的患者之间的战略互动.
主要方法:
- 利用进化游戏理论来构建一个三方进化游戏模型.
- 分析了地方政府 (LG),高级医疗机构 (SMI) 和患者的战略稳定性.
- 对模型中的关键参数进行了灵敏度分析.
主要成果:
- 地方政府采用DIP受到区域间社会福利的影响.
- 当DIP下的患者减少率较低时,SMI对HMS的支持会增加.
- 患者的决策主要是由初级医疗机构 (PMI) 的感知质量驱动的.
结论:
- 在具有强有力的政策,充足的资源和高质量的初级保健的地区,DIP更有可能促进HMS.
- 需要有效的激励措施来鼓励所有利益相关者的参与.
- 该研究提供了评估支付改革的方法框架.
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