新型农村合作医疗费用监管机制研究

The research on the expenses supervision mechanism of the New Rural Cooperative Medical Scheme

构建医疗机构与经办机构之间的静态不完全博弈模型,分析经办机构监管的概率与医疗机构不努力控制费用的概率之间的关系。博弈模型求解结果显示,达到均衡点时,加大监管力度可以通过遵循加大处罚力度、减小监管成本、增加政府和公众压力与舆论三个渠道构建。加大处罚力度包括行政处罚和经济处罚两方面;监管成本减小可以通过建立医疗机构监管委员会和促进县级医疗机构之间形成竞争机制两方面实现;增加政府和公众压力与舆论,可以通过加大政府行政管理力量、加强社会监管力度、建立三方共同参与的卫生服务信息发布制度三方面实现。

This paper analyzes the relationship between the probability of the supervision in the agency and that of less incentive in controlling the expenditure in medical institutions, through building a static game model of incomplete information. The equilibrium results of the model show that the increasing intensive supervision could be achieved through severe punishment, reducing the cost of the supervision, and increasing the pressure and public opinion from the government and the public. Severe punishment includes the administrative penalty and financial penalty. Reducing the cost of the supervision includes establishing the supervision board and the competition mechanisms. Increasing the pressure and public opinion from the government and the public includes strengthening the ad- ministration of the government in line with tightening the social supervision and building the health service information release system.