奖励合同下我国公立医院降低不合理医疗费用的路径选择

Research on the Path Choice of the Reducing Unreasonable Medical Expenses in Public Hospitals of China under the Incentive Payment Contract

目的:探讨降低我国公立医院不合理医疗费用的有效途径。方法:在政府或主管部门为医生提供降低医疗费用奖励合同的条件下,通过建立数理模型分析了医生是风险中性和风险规避时在降低医疗费用方面的努力水平、行为决策及其影响因素。结果:诊治疾病所需的基本医疗费用对医生的最优努力水平影响是负向的,医生努力水平的有效性、其他医生的努力水平、不同医生间的竞争强度对医生最优努力水平的影响是正向的。而边际奖励、医生的风险规避程度和政府给予医生奖励的医疗费用临界水平对医生最优努力行为的影响,都将依据约束条件的不同而不同。结论:政府或主管部门应根据上述分析结果提供相应路径选择。

Objective: To discuss the effective ways to reduce the unreasonable medical expenses of the public hospitals in China.Methods: It built the mathematical models to analyze the decision of the effort level and its influential factors about the reduction of the medical costs for the risk-neutral doctors and the risk-averse doctors under the condition that the government or the authorities provided doctors with an incentive payment contracts for the effort to reduce the medical costs and doctors in the public hospitals in China. Results: The basic medical expenses for the diagnosis and treatment of diseases had negatively effect on the optimal effort level of doctors. The effective degree of effort, the effort level of the other doctors and the intensity of competition between different doctors all had positive effect on the optimal effort level of doctors. However, the marginal incentive payment, the degrees of risk-aversion and the critical level of medical costs of the payment obtained from the government had different effects on the effort level according to the different constraint conditions. Conclusion: The government or the authorities should provide the path choice according to these results.