过度医疗的解决之道:管制价格、强化竞争还是改革付费?

Dealing With the Issue of Supplier-Induced Over-Consumption:Price Regulation,Competition,or Provider-Payment Reforms?

为控制医疗费用上涨趋势,政府采取了多种价格管制政策,但呈现严重的管制失灵之势。在价格管制之外,存在另两种解决过度医疗行为的政策建议,即"强化竞争"和"付费改革"。本文通过对强化竞争、价格管制、付费改革三种方式进行对比分析,指出在信息不完全的现实市场中,强化竞争并不能改变医疗市场的垄断竞争态势,甚至可能加剧医生的供方诱导需求行为。现有的价格管制的政策实践也说明,忽略信息问题和激励问题的传统管制策略,会造成被管制者行为的严重扭曲。因此,建立在新规制理论基础之上的医保付费改革,即通过公共契约模式重构激励机制,才是解决中国过度医疗问题的根本之道。

To curb the rising trend in healthcare expenditures,the Chinese government has been conducting a series of price regulations,but regulatory failure prevails.Besides price regulation,there are two other alternative ways to deal with the issue of supplier-induced over-consumption,namely intensifying competition among providers and reforming provider-payment modes.By conducting a comparative analysis of the three alternatives,this paper argues that in a market with incomplete information,intensifying competition among providers does not lead to a change in the situation of monopolistic competition in the healthcare sector,and may exacerbate the existing situation of supplier-induced demand.The existing practice of price regulation shows that the traditional regulatory measures that ignore the problems of information and incentive will lead to the severe distortion of behaviors among the regulated.Hence,the providerpayment reforms,based on the new regulation theory,perform as feasible solutions for dealing with the issue of supplier-induced over-consumption,by restructuring incentive mechanisms through the public contracting model.