DRG制度对三级医院疾病诊治难度的演化博弈及实证分析

Evolutionary game and empirical analysis of DRG system on the difficulty of diseases diagnosis and treatment in tertiary hospitals

目的用演化博弈理论分析DRG制度对三级医院疾病诊治难度的影响。方法通过理论分析医疗机构的策略及行为收益,构建演化博弈模型,通过软件模拟仿真分析各种因素对医院疾病诊治难度的影响,并通过实证分析验证模型的正确性。结果正常情况下,即使科室群体中选择提升疾病诊治难度策略的初始比例只有1%,只经过6.13个仿真周期,提升疾病诊治难度策略就能快速覆盖95%以上的群体。当医保费率过低时,医院将选择不提升疾病诊治难度。实证数据证明了本研究构建的演化博弈模型的正确性。结论DRG将促使三级医院提升疾病诊治难度,研究构建的模型在预测、调整、控制等方面有较强的实用性,医院群体中采取不同初始策略的个体比例对演化均衡时间有较大影响,必须注意医保费率过低时,医院将选择不提升疾病诊治难度。

Objective To analyze the influence of DRG system on the difficulty of diagnosis and treatment of diseases in tertiary hospitals with the evolutionary game theory.Methods Through theoretical analysis of strategies and behavioral benefits of medical institutions,an evolutionary game model was constructed,the influence of various factors on the difficulty of diagnosis and treatment of hospital diseases was analyzed by software simulation,and the correctness of the model was verified by empirical analysis.Results Under normal circumstances,even if the initial proportion of departments who choose the strategy of improving the difficulty of diagnosis and treatment of diseases is only 1%,after only 6.13 simulation cycles,the strategy of improving the difficulty of diagnosis and treatment of diseases can quickly cover more than 95%of the groups.When the medical insurance rate is too low,hospitals will choose not to improve the difficulty of disease diagnosis and treatment.Empirical data prove the correctness of the evolutionary game model constructed in this study.Conclusion DRG will promote the difficulty of diagnosis and treatment of diseases in tertiary hospitals.The model constructed in this study has strong practicability in prediction,adjustment and control.The proportion of individuals adopting different initial strategies in hospital group has a great influence on evolutionary equilibrium time.It must be noted that when the medical insurance rate is too low,the hospital will choose not to the difficulty of disease diagnosis and treatment.