医保支付与医生薪酬的激励转化机制研究——DRG付费下的实验研究证据

Study on the transformation mechanism between medical insurance payment and physician salary incentives:Evidence from experiment study under DRG

目的:探究与DRG支付方式改革相适应的医生薪酬激励设计,为优化医保支付方式改革相关政策提供参考依据。方法:利用经济学实验,设计七种将DRG支付激励转化为薪酬激励的医生薪酬支付方式,招募210名医学生和65名医生作为被试人员,测试其在不同薪酬激励下为患者提供的医疗服务数量及相应患者健康效益。结果:向医生反馈DRG支付情况或将DRG支付结余与医生绩效工资挂钩均会将支付方式的激励传导给服务提供者,在此基础上,引入以质量为基础的按绩效支付,被试者提供的服务量与最优服务量之间的差值减小,患者健康效益损失比也降低。结论:在将DRG支付激励传导给服务提供者时,与以质量为基础的按绩效支付相结合的医生薪酬设计更有利于提高患者健康效益。

Objective:This study explored the designs of physicians compensation incentives that were compatible with the reform of Diagnosis-related groups(DRG)payment,so as to provide a reference for optimizing policies related to medical insurance payment reform.Methods:We designed seven different physicians compensation schemes that converted DRG payment incentives into salary incentives,using economic experiments.The total of 210 medical students and 65 doctors were recruited as subjects.We tested the quantity of medical services for patients that participants provided and the corresponding patient health benefits under different incentive schemes.Results:The two designs of feedback of DRG payment to physicians and linking DRG payment surplus to physicians performance wages both could transmit the incentive of the payment methods to the service providers.On this basis,a quality-based pay-for-performance payment was introduced,and the deviation between the quantity of services provided by subjects and the optimal quantity of services decreased,and the loss ratio of patient health benefits also decreased.Conclusion:When transmitting DRG payment incentives to medical service providers,the physician compensation design combined with quality-based pay-for-performance payments is more conducive to improving patient health benefits.