基于不完全契约理论的DRG付费方式改革对医院行为影响研究

Study on the Impact of DRG Payment Reform on the Behavior of Hospitals Based on Incomplete Contract Theory Model

DRG付费方式改革是我国推进医药卫生体制改革进程中的重要举措.借助不完全契约理论分析框架,分析在缔约过程中DRG付费方式在不同契约关系发展时期对医院行为产生的影响.研究发现,在关系初建0期医保支付方具有绝对的剩余控制权,在关系执行1期时医院在得到正确正向激励时会产生正向效用预期行为,如加强成本管控行为、规范医务人员行医行为、适度控制检查行为、避免大处方行为等.若发生不公正对待或负向刺激时,医院管理者会通过信息不对称优势索取剩余控制权,产生某些准租行为.因此,应根据我国的区域差异和医院分类,精准且差异化实行DRG付费制度,通过完善利益分配机制来提高DRG付费运行的效率与效果.

DRG payment reform is an important measure to promote the reform of health care system in China.In this study,through the analysis of the framework of incomplete contract theory,the impact of DRG payment on hospital behavior in different stages of contract relationship development is analyzed.It is found that the payer of medical insurance has absolute residual control right in the initial stage of relationship construction,and when the hospital gets the right positive incentive in the first stage of relationship implementation,it will produce positive utility expected behavior,such as strengthening cost control behavior,standardizing medical staff’s medical practice behavior,moderately controlling inspection behavior,and avoiding large prescription behavior,etc.In case of unfair treatment or negative stimulation,hospital managers will ask for the residual control right through the advantage of information asymmetry,resulting in some quasi rent behaviors.Therefore,according to the regional differences and hospital classification in China,DRG payment system should be implemented accurately and differentiated,and the efficiency and effect of DRG payment operation should be improved by improving the benefit distribution mechanism.