价格上限管制下的预付制比较:总额预付制与按人头付费制

Price Ceiling and Prospective Payment Systems: Global Budget and Capitation

本文从我国医疗市场的价格上限管制背景出发,研究并对比了总额预付和按人头付费这两种预付制的效果。研究表明,价格上限管制不仅削弱了总额预付制和按人头付费制对过度医疗的约束效果,而且强化了医生推诿医保患者的动机。此外,尽管无价格上限管制时两种预付制的调节效果是确定且等价的,但引入价格上限管制后,总额预付制的实施效果受到实际就诊人数的随机冲击的影响,使得按人头付费制成为比总额预付制更加稳定可控的政策选择。

This paper analyzes the effects of global budget and capitation under the price ceiling in Chinese medical market. The analysis shows that price ceiling does not only weaken the constraints of global budget and capitation on overtreatment, but also leads to dumping. Moreover, although the effects of these two payment schemes are certain and equivalent in a market without price regulation, the effects of global budget turn out to be influenced by fluctuations of the number of patients under price ceiling, implying that capitation would be a more steady and feasible option.