风险分担、激励和医疗保险支付方式改革

Risk Sharing, Incentives and Reform of Payment Methods for Medical Insurance

本文以委托—代理理论为基础,在信息不对称条件下,代理人的努力水平不能被委托人有效观测,帕累托最优合同是不能实现的。因此,为降低委托—代理成本,实现最优激励,代理人必须承担风险。在我国医疗保险支付方式改革实践中,按病种诊断分组预付制付费机制可以在一定程度上降低信息不对称,以标准化方式平均医疗服务费用和医疗服务成本,判断不同医院和医生的行动水平,并以此为依据实施激励,通过风险分担和激励约束有利于实现帕累托改进,这也为我国医疗卫生体制改革中的医疗保险支付方式改革提供理论和实证支持。

Based on the principal-agent theory,this paper holds that under the condition of information asymmetry,the behavior level of the agent can not be effectively observed by the principal,and Pareto Optimal contract can not be realized.Therefore,in order to reduce the agency cost and realize the optimal incentive,the agent must take the risk.In the practice of the reform of payment methods for medical insurance in China,the payment mechanism according to the group prepayment system can reduce the information asymmetry to a certain extent,determine the average medical cost and the cost of medical service in a standardized way,judge the behavior level of different hospitals and doctors,and use this as the basis to implement the incentive,through effective risk sharing and incentive constraints,it is beneficial to achieve Pareto improvement.This also provides theoretical support for the reform of payment methods for medical insurance in the reform of medical and health system in China.