摘要
德国为了控制医疗费用支出,在门诊部门实施总额预算下的按项目付费式点数法。作者运用博弈论构建德国点数法下的医师博弈模型,阐述了医师"冲点"行为产生的原因及其负面效应以及德国针对"冲点"行为采取的防控措施及其作用原理。我国多地在住院部探索实行点数法支付,其通过绩效分配模式传递到医疗服务提供者并影响其行为,部分地区也会出现争夺病源、低标准入院、高套分值等"冲点"行为。借鉴德国防控经验,建议我国采取动态检测、披露"冲点"行为、完善分级诊疗以及发挥行业协会自治作用等防控措施,进一步规范医疗行为。
Germany has introduced the"point method"of fee-for-service at the outpatient departments under a global budget system,in an effort to curb medical expenditure growth.The authors employed the game theory to build a physician′s game model under Germany′s point method,illustrating the causes of"increasing points"behaviors of physicians,the negative effects caused by the increase of points as well as the prevention and control measures employed by Germany and its mechanism.Point method payment has been introduced in several areas in China at their inpatient departments,which is delivered to medical service providers via the performance-based distribution model,with the providers affected in their behaviors.As a result,some areas will tend to appear such"increasing points"behaviors as competing for patients,lowering admission criteria,and raising point value.In view of Germany′s experiences,China should adopt such measures as dynamic monitoring system,disclosure of"increasing points"behaviors,perfection of hierarchical medical system,and strengthening the self-governance via medical sector′s associations.
作者
黄雨萌
钟正东
曾理
吴文琪
刘宵
项莉
Huang Yumeng;Zhong Zhengdong;Zeng Li;Wu Wenqi;Liu Xiao;Xiang Li(Tongji Medical College of Huazhong University of Science and Technology,School of Medicine and Health Management,Wuhan 430030,China)
出处
《中华医院管理杂志》
CSCD
北大核心
2020年第8期698-701,共4页
Chinese Journal of Hospital Administration
基金
国家自然科学基金(71874058)。
关键词
医保支付方式
点数法
博弈论
医疗费用控制
德国
Payment method of health insurance
Point method
Game theory
Medical expense control
Germany
