社会保障研究
社會保障研究
사회보장연구
Social Security Studies
2010年
1期
70~72
,共null页
医疗费用支付方式 博弈 帕累托最优
醫療費用支付方式 博弈 帕纍託最優
의료비용지부방식 박혁 파루탁최우
medical expenses payment pattern, game, Pareto optimality
医疗费用控制是世界难题，原因在于现行医疗费用支付方式下医保和医院的博弈不存在医疗资源配置帕累托最优的均衡解。当医保按服务项目支付时，医院会选择过多服务策略；当医保按总额预算支付时，医院会选择过少服务策略。如果医保在支付周期的期末确定医疗费用支付方式，则医院会选择按预算总额提供服务策略，医疗资源配置也不能实现帕累托最优。改变动态博弈模式为静态博弈模式，并且医保以随机方法决定医疗费用支付方式，则只要支付方式的概率分布选择合理，博弈的均衡总能够实现医疗资源配置的帕累托最优。
醫療費用控製是世界難題，原因在于現行醫療費用支付方式下醫保和醫院的博弈不存在醫療資源配置帕纍託最優的均衡解。噹醫保按服務項目支付時，醫院會選擇過多服務策略；噹醫保按總額預算支付時，醫院會選擇過少服務策略。如果醫保在支付週期的期末確定醫療費用支付方式，則醫院會選擇按預算總額提供服務策略，醫療資源配置也不能實現帕纍託最優。改變動態博弈模式為靜態博弈模式，併且醫保以隨機方法決定醫療費用支付方式，則隻要支付方式的概率分佈選擇閤理，博弈的均衡總能夠實現醫療資源配置的帕纍託最優。
의료비용공제시세계난제，원인재우현행의료비용지부방식하의보화의원적박혁불존재의료자원배치파루탁최우적균형해。당의보안복무항목지부시，의원회선택과다복무책략；당의보안총액예산지부시，의원회선택과소복무책략。여과의보재지부주기적기말학정의료비용지부방식，칙의원회선택안예산총액제공복무책략，의료자원배치야불능실현파루탁최우。개변동태박혁모식위정태박혁모식，병차의보이수궤방법결정의료비용지부방식，칙지요지부방식적개솔분포선택합리，박혁적균형총능구실현의료자원배치적파루탁최우。
Medical expenditure control is a difficult international problem. It is because that equilibrium solution of Pareto optimality do not exist in the game between the medical insurance and hospital under the current medical expenses payment pattern. When medical insurance is paid for service, hospital could choose excessive services strategy; when medical insurance is paid for global budget, hospital could choose too few services stategy. If medical expenses payment pattern of medical insurance is determined at the end of pay cycle, hospital would choose the stategy of providing service according to global budget, and medical resource allocation also cannot achieve Pareto optimality. Changing dynamic game mode to static game mode, and medical expenses payment pattern of medical insurance is determined by random method, then if probability distribution of payment patern is chosen reasonable, the equilibrium of game could always realize Pareto optimality of medical resource allocation.
