基于动态博弈的远程医疗政策与患者社会福利研究

A Study of Telemedicine Policy and Patients’ Social Welfare Based on Dynamic Game

为了研究远程医疗的有效政策以及政策对患者社会福利的影响,考虑一个由政府、医院和患者三个主要利益相关者构成的医疗系统,利用动态博弈等理论建立了三种博弈模型:完全竞争条件下的两阶段动态博弈模型、医保报销比例政策下的三阶段动态博弈模型、医保报销比例和医疗服务价格限制双重政策下的三阶段动态博弈模型。研究结果表明,患者社会福利在完全竞争博弈中最低,在医保报销比例政策下的博弈中次之,在医保报销比例和医疗服务价格限制双重政策规制的博弈中最高。将远程医疗纳入医保范围,并给予较高的医保报销比例,既有利于远程医疗市场占有量的增长,又有利于患者社会福利的增加。但较高的医保报销比例会使远程医疗和传统医疗服务价格都显著上涨,必须施加医疗服务价格限制,以控制价格的上涨,减少社会医疗成本。最后,算例和敏感性分析验证了模型的有效性和正确性。

Telemedicine can ease the contradiction between the rapidly increasing number of elderly people and the serious shortage of medical resources in China. However, the application of telemedicine in china is not ideal. Therefore, it is very necessary to study the effective policies of telemedicine. The government is the organizer and policy maker of a national medical system. The government’s medical policy determines the development of a country’s medical market. Therefore, the government is introduced as the decision-making subject into the game process of the medical system. By a medical system consisting of three major stakeholders: government, medical institutions and patients, based on the optimum of the patient’s social welfare, the patients’ social welfare level, social medical treatment cost, telemedical price and market share are studied under the different medical service price policy and payment policy.First, three game models are established by using the dynamic game theory: the two-stage game model under the condition of perfect competition market, the three-stage game model under the policy of medical insurance reimbursement, and the three-stage game model under the dual policy of medical insurance inreimbursement and medical price restriction. Secondly, comparative research method is used to analyze the differences of medical system in medical price, market share, patients’ social welfare level, social medical cost, etc under perfect competition, single government policy and two government policies. Finally, an example is given to describe the difference of the three game results, and the sensitivity of medicare reimbursement policy is analyzed by numerical simulation. The data used in this article is simulated data.The research conclusion shows that the social welfare of patients is the lowest in the perfect competition game, the second in the policy of medical insurance reimbursement, and the highest in the dual policy of insurance reimbursement and price restriction of medical service. The inclusion of telemedicine in the coverage of medical insurance and the higher reimbursement rate of medical insurance are not only conducive to the growth of the market share of telemedicine, but also conducive to the increase of the social welfare of patients. However, the higher reimbursement rate of medical insurance will significantly increase the price of telemedicine and traditional medical services, so the price limit of medical services must be imposed to control the price rise and reduce social medical costs. This study provides theoretical support for the formulation of telemedicine policies, and then guides the specific operation of telemedicine policies in practice.