奖励合同下医生降低不合理医疗费用的努力水平研究

Research on the Effort Level of Reducing Unreasonable Medical Expenses from the Doctors of the Public Hospitals in China Under the Incentive Payment Contract

目的探讨降低我国公立医院不合理医疗费用的有效途径。方法在政府或卫生主管部门为医生提供降低医疗费用奖励合同的条件下,通过建立数理模型分析了风险规避型医生在降低不合理医疗费用方面的努力行为决策及其影响因素。结果诊治疾病所需的基本医疗费用对医生的最优努力水平影响是负向的,医生努力的有效性、其他医生的努力水平、不同医生间的竞争强度对医生最优努力水平的影响是正向的。而边际奖励、医生的风险规避程度和政府给予医生奖励的医疗费用的临界水平对医生最优努力行为的影响,都将依据约束条件的不同而不同。结论政府或主管部门应根据上述分析结果提供相应奖励合同。

Objective To discuss the effective ways to reduce the unreasonable medical expenses of the public hospitals in China.Methods Building the mathematical models to analyze the decision of the effort level and its influential factors about the reduction of the medical cost for the risk-averse doctors under the condition that the government or the authorities providing doctors with a incentive payment contracts for the effort to reduce the medical cost in public hospitals.Results The basic medical expenses for the diagnosis and treatment of diseases have negative effect on the optimal effort level of doctors.The effective degree of effort,the effort level of the other doctors,and the intensity of competition among different doctors all have positive effect on the optimal effort level of doctors.But the marginal incentive payment,the degrees of risk-aversion,and the critical level of medical costs of the payment obtained from the government have different effect on the effort level according to the different constraint conditions.Conclusion The government or the authorities should provide corresponding incentive payment contracts according to these results.