线上线下融合的诊疗努力分配决策研究

Healthcare Effort Decision on Online⁃Offline Service Allocation

线上线下融合成为保障医疗服务连续性,提升服务质量,降低患者再入院率的有效措施。基于医疗服务提供者(healthcare provider,HCP)难以平衡线上线下服务间有限诊疗资源分配的现状,本文针对诊疗后期将病人由线下转至线上的行为,建立按服务项目付费(fee-for-service,FFS)、预付制(prospective payment system,PPS)、捆绑支付(bundled payment,BP)和按绩效付费(pay-for-performance,P4P)四种支付方式下HCP与政府间博弈模型,研究激励HCP合理分配线上线下诊疗资源的医保支付方式。研究结果表明:FFS难以激励HCP在线上护理治疗阶段付出努力;PPS和BP虽然能诱导一定程度的线上诊疗努力,但始终无法协调至社会最优,增加支付金额也并不一定能够提高线上努力水平;基于P4P的再入院减少计划(hospital readmission reduction program,HRRP)下加大处罚力度不一定是最优选择,也并不总能将线上诊疗努力水平协调至社会最优;最后,本文提出取消HRRP罚款上限并设置奖励规则的混合支付方式可以弥补HRRP不足,并有效协调线上诊疗努力水平至社会最优。

In the post epidemic era,online⁃offline integration has become an effective method to ensure the continuity of healthcare serv⁃ices and improve the service quality.In this study,we develop a game⁃theoretical model between a Healthcare Provider(HCP)and a government under Fee⁃for⁃Service(FFS),Prospective Payment System(PPS),Bundled Payment(BP)and Pay⁃for⁃Performance(P4P).We consider the behavior of the HCP in transferring patients from offline to online at a later stage and discuss reimbursement schemes that incentivize the HCP to rationally allocate online and offline healthcare resources.The results show that FFS does not inspire the HCP to make efforts in online treatment.PPS and BP can improve online treatment efforts,but they cannot coordinate to the social optimum,and the increase of payment amount does not improve online treatment efforts.Under the Hospital Readmission Reduction Pro⁃gram(HRRP)based on the P4P,increasing the punishment is not always the best choice,nor can it always coordinate to the social op⁃timum.We also find that the hybrid payment,canceling the upper limit of HRRP fine and setting reward rules,can make up for the shortcomings of HRRP and effectively coordinate to social optimum.