博弈论视角下的医保定点医疗机构监管分析

Supervision Analysis of Designated Medical Institutions which Support Social Health Insurance in the Perspective of Game Theory

定点医疗机构和监管机构是对医保定点医疗机构进行监管所涉及的两个主体。而监管机构是政府的代表,对医疗机构监管不到位会导致医疗机构的一系列违规行为,最终导致社会利益受损。本文运用博弈论理论,构建和分析定点医疗机构和监管机构的博弈模型,指出降低监管成本、增加处罚罚金和增加医保带来的社会利益是决定医保定点医疗机构监管成果的三大最主要因素。

Designated medical institutions and supervision institutions are two main bodies which supervise designated medical insti-tutions supporting social health insurance. Supervision institutions are the representative of the government. The less supervision of medical institutions will lead to a series of illegal behavior, and ultimately result in damage to social interests. This paper made use of game theory to construct and analyze the game theory mode of designated medical institutions and supervision institutions, and pointed out that reducing supervising cost, increasing fines and social benefits of health care are the three major factors which can decide the regulatory result of designated medical institutions supporting social health insurance.