DRGs医保支付方式下双向转诊机制的演化博弈与仿真分析

Evolutionary Game and Simulation Analysis of Two-way Referral Mechanism Based on DRGs Medical Insurance Payment Method

双向转诊机制能够优化卫生资源配置,降低医疗费用,促使医疗机构职能分明,提高整个医疗体系的效率,是解决我国“看病难、看病贵”问题的突破口。为探究DRGs医保支付方式对于双向转诊机制的影响,构建了上下级医院及政府在内的三方博弈模型,对各医疗机构的转诊决策过程进行演化分析。运用系统动力学对该过程进行仿真,得出如下结论:严格控制按DRGs付费政策的规范性,可以规避医疗不足的风险,提高患者效益增量;DRGs分组定价合理,能够充分发挥按DRGs付费对双向转诊的促进作用,引导各级医院形成双向转诊合作。

The two-way referral mechanism can optimize the allocation of health resources,reduce medical expenses,promote clear functions of medical institutions,and improve the efficiency of the entire medical system.It is a breakthrough to solve the problem of"difficult and expensive medical treatment"in my country.In order to explore the factors that influence the implementation of the twoway referral mechanism based on the DRGs medical insurance payment method,a tripartite game model was built between the upper and lower hospitals and the government.The evolutionary analysis of the referral decision process of each medical institution was given.Using system dynamics to simulate the process,the following conclusions are drawn:strictly controlling the standardization of DRGs payment policy can avoid the risk of inadequate medical care and increase patient benefit;DRGs group pricing is reasonable,and can give full play to the two-way transfer of DRGs payment.The promotion of medical consultations has guided hospitals at all levels to form two-way referral cooperation.