慢性病按总额支付方式对医联体预防激励的影响

Influence of bundled payment of chronic disease on the preventionincentive of medical association

针对慢性病患者在就医过程中支付方式和医院的选择不同,按总额支付方式对医院预防努力的激励作用,建立了医联体成本最小化模型,计算和比较了社区医院最优预防努力、三级医院最优治疗努力和患者最小成本.结果表明,当医联体的边际收益率较低时,患者发生并发症后选择医联体内治疗时社区医院预防努力、三级医院治疗努力都比选择医联体外治疗时大.从患者健康角度考虑,患者发生并发症后医联体将引导患者选择在医联体内治疗.

This paper studies the incentive effects of bundled payment on hospital prevention efforts for different payment modes and hospital selections in the process of chronic diseases patient’s medical treatment.This study builds optimization models which minimize the costs of the medical association.The optimal prevention efforts of the community hospital,the optimal treatment efforts of the tertiary hospital and the minimum costs of patients are calculated and compared.The results show that when the marginal rate of the medical association is low,the prevention efforts of the community hospital and the treatment efforts of the tertiary hospital are greater when the patient with complications is treated in the medical association than outside the association.The medical association should guide the patient to choose treatment in medical association when the patient has complications,from the perspective of patient health.