构建公立医院内部医保基金控制模型的实践研究

Practical Analysis on Establishing the Control Model of Medical Insurance in Public Hospital Internal Operation Based on Utility Theory

目的:构建医院内部医保基金控制模型,提高医保基金内部控制的有效性。方法:运用效用理论建立满足医疗服务提供者个体理性约束和激励相容约束条件下的医院管理者期望效用最大化模型。结果:运用进化规划算法进行实证计算,得出奖励系数和惩罚系数。结论:医院内部医保基金控制模型对控制医保统筹费用的使用起到了一定的作用,也为公立医院建立医保管理考核机制和内部运行激励机制提供指导和参考。

Objective： To estahlish the control model of medical insurance in hospitals, so as to improve the effectiveness of internal operation for medical insurance fund. Methods： Using the utility theory to establish the control model, with which the medical service provider is individual rationality constraints and incentive compatibility constraint. Results： The bonus coefficient and punishment coefficient can be calculated by means of evolutionary programming. Conclusion： The control model of hospital internal medical insurance fund is useful in controlling the medical insurance expense, it also proyides the guidance and references fi）r performance management and internal operation.