按病种付费下医生的隐藏特征问题分析

Problem Analysis of Doctors' Hidden Characteristics Under Diagnostic Related Groups Based Payment

按病种付费作为控制医疗费用过快上涨的一项支付方式改革,在我国的进展较为缓慢且改革效果未及预期,主要原因之一是来自医生的阻力。研究借用委托代理理论分析医生作为代理方在执行按病种付费改革过程中,如何利用自己的信息优势而采取机会主义行为,产生隐藏特征问题如何对改革的进展和效果起到阻碍作用,为进一步完善按病种付费制度提供参考建议。

DRGs, as one of payment reforms of medical cost containment, has been progressed slower and less effective than anticipated in China. One of the main reasons is the resistance from doctors. The study used principal-agent theory to analyze how the doctors take advantage of their information and adopt opportunistic behavior in the process of DRGs payment reform, how the hidden characteristics problem impeded the reform progress and affected the reform outcome. Based on the analysis, the study offers some suggestions for DRGs reform further improvement.