通讯作者: 项莉, xllyf@126.com

DOI：10.12201/bmr.202207.00022

Analysis on the rush point behavior of medical institutions under the total budget of regional point method ——Take DIP payment method as an example

• 摘要：区域点数法总额预算作为一种预算控制方式，可以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”行为有助于对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为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。医保部门需要在优化支付、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

   

  Abstract: As a budget control method, the total budget of regional point method can be combined with different payment methods. Exploring the punching point behavior of medical institutions under the total budget of regional point method will help to improve the operation mode of medical insurance payment. This study combs the rush point behavior of medical institutions under the total budget of the regional point method, and uses 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. According to the game model, the strict advantage strategy of dip payment is all kinds of rush point behaviors including unreasonable medical treatment. The amount of punishment for unreasonable rush point behavior, the supervision cost of medical insurance agencies, and the amount of additional income from unreasonable rush point behavior have an impact on the unreasonable rush point behavior of medical institutions and the degree of supervision of medical insurance agencies. The medical insurance department needs to optimize the payment, supervision mechanism and other implementation modes to reduce unreasonable rush point behavior.

  Key words: DIP; Rush point behavior; Total budget of regional point method; Medical insurance payment method

  提交时间：2022-07-11

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
• html

• 图表

• 许光建, 乔羽堃. 我国医疗服务价格调整与医保支付方式改革的联动机制研究. 2021. doi: 10.12201/bmr.202104.00018

  张婧怡, 高广颖, 胡星宇, 邓茜, 张达, 田佳帅, 张礼亮. 基于META分析的肺结核患者按病种支付方式实施效果研究. 2022. doi: 10.12201/bmr.202112.00012

  钟玉英, 钟文珊. 第三次分配视角下网络公益众筹助力医疗救助的发力点及监管重点. 2021. doi: 10.12201/bmr.202110.00040

  伍琳, 李梦颖. 医保支付激励与医生多任务执行偏差——新的解释框架和政策启示. 2022. doi: 10.12201/bmr.202112.00013

  郝倩, 章平. DRG付费模式下医保监管系统设计与实现. 2021. doi: 10.12201/bmr.202108.00018

  王超, 王培刚. “统一大市场”背景下区域医疗资源共享路径探析. 2022. doi: 10.12201/bmr.202209.00013

  于晨, 侯建林, 王丹, 谢阿娜, 王维民. 我国本科医学院校布局及其区域差异性研究. 2021. doi: 10.12201/bmr.202104.00021

  赵君, 丁雪, 陈永超, 王芳. 我国部分地区妇幼健康分级服务政策实践分析. 2021. doi: 10.12201/bmr.202012.00016

  陈迎春, 谭华伟. 中国紧密型县域医共体医保支付的财务脆弱性与风险保护:风险识别、经验镜鉴与政策路径. 2022. doi: 10.12201/bmr.202212.00003

  张金穗, 胡敏, 陈文, 龚忆莼, 李建梅. 我国基本医疗保险参保人信用管理内容设计的探索与启示——基于18省市信用管理政策文本的内容分析. 2022. doi: 10.12201/bmr.202207.00025

• 序号	提交日期	编号	操作
  1	2022-04-12	bmr.202207.00022V1	下载

• 公开评论  匿名评论  仅发给作者 提交评论