通讯作者: 项莉, D202281851@hust.edu.cn

DOI：10.12201/bmr.202305.00002

Exploration on the integration policies of DIP payment and total budget payment of close medical community

• 摘要：摘要 基于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; ; ; 

   

  Abstract: Abstract Based on the policy framework of DIP, explore the integration mode of DIP payment and the total budget payment of close medical community, and analyze the impact of each mode on the service behavior of medical community. This research applies game theory to build game models under three combination modes from the two levels of government and the close medical community, the close 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 is easy to lead to internal and external competition in the medical community. When it is only used for external payment, not for internal distribution, it still continues to expand its service externally. The design space of internal distribution system is insufficient. When it is not used for external payment but only for internal distribution, it is helpful to weaken the disorder competition of the medical community outside by paying according to the total head amount. At the same time, through the DIP payment rules, different point values in the region are applied to regulate the unreasonable behavior of medical institutions to maliciously expand the service volume.

  Key words: DIP; Payment method of medical insurance; Total budget payment; Close medical community

  提交时间：2023-05-09

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• 序号	提交日期	编号	操作
  1	2022-12-27	bmr.202305.00002V1	下载

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