医保支付对医生行为影响的经济分析

An Economic Analysis of Health Care Payment Effects on Physician Behavior

分析医保支付方式对医生行为的影响,探索完善医生代理人作用的最优医保支付方式。根据经济学中的成本效用理论推导中性医保支付方式的经济学原理,从而验证经济中性支付方式存在以及对医生行为影响的可能性。证明采取以医疗服务数量无关的预付制为基础,混合以边际成本小于边际费用的按成本支付制度可以实现医保支付的中性。这种支付制度不仅能促进医生完善其代理人作用,而且有助于抑制医生诱导需求和参保人的道德风险。

This paper analyzed the effect of the health care payment on physician behavior, and explored the optimal health care payment that can improve physician agency. According to the theory of cost-utility, this paper proposed the neutrality principle of payment system, and described how a neutral payment system affected physician behavior. As a result, a neutral payment system implied a positive prospective payment independent of the services coupled with a fee less than marginal cost. On the one hand, prospective payment in a mixed system gave physician the financial support and the incentive to attract and accept patients. On the other hand, the fee-based payment protected the physician against physician-induced demand and the moral hazard of the insured. Therefore, the mixed system can improve physicians＇ agency.