基于人保健康“湛江模式”的健康保险多方博弈研究

Multiple-party game analysis based on PICC Health′s "ZhanJiang Model"

人保健康"湛江模式"在实践中探索出了一条实现政府、健康保险公司、被保险人、医疗服务提供者之间多方共赢的健康保险经营之路。本文从总结和研究"湛江模式"的主要做法和经验出发,分析了政府机构和健康保险公司、健康保险公司和医疗服务提供者之间的博弈过程,探讨了"湛江模式"取得成功背后的博弈机制。研究表明,只有通过合理的制度设计,才能够促使多方进行合作博弈,达到被保险人保障提高、政府机构负担降低、医疗资源充分利用、健康保险市场繁荣的目标。

PICC Health ＂ZhanJiang Model＂ has created an innovative business model which could achieve the multi-win situation among government, health insurance companies, the insured and medical service providers. This article summarized the main practices and experiences of ＂ZhanJiang Model＂, analysed the game processes between government and health insurance companies, and health insurance companies and medical service providers. After that,the article explained the Game theorem behind the success of ＂ZhanJiang Model＂. It concluded that the multicooperation game processes could only come from a reasonable system design which ensured reaching the targets of increasing the insurance coverage of the insured, alleviating government burden, utilizing medical resources effectively and flourishing the health insurance market.