【摘要】 我国医疗保险支付方式改革的重点之一是将过去的按服务项目付费转变为按病种付费。通过建立两种医疗支付方式下医患、医院与医保局双方的博弈模型,分析了2种支付方式下博弈各方的行为特点。分析表明,按病种付费在控制不合理医疗费用上相较于按服务项目付费更优。不论在哪种支付方式下,优化医保监督管理方式使得监管难度降低的同时,增大处罚力度也是遏制医院不合理医疗的有效途径。更多还原

【Abstract】 A priority of payment pattern reform in national medical insurance is to transform the fee-for-services(FFS)into Diagnosis Related Groups(DRGs).Through establishing the game models between doctors and patients,and between hospitals and national insurance institutions,we analyzed the behavior characteristics of the game participants under the two different payment pattern of medical insurance.As conclusions,DRGs was proved to be more superior than FFS in controlling unreasonable medical fee.No matter under which payment pattern,optimizing the methods of medical insurance management and enhancing the penalty of violations are useful ways to reduce unreasonable medical fee.更多还原