推动中医药医保支付方式改革,探索符合中医药特点的支付方法和管理机制具有重要意义。基于国家医疗保障局推行的按疾病诊断相关分组(Diagnosis Related Groups,DRG)付费和现行医保支付中按项目支付方式,借助博弈理论分析两种支付方式下...推动中医药医保支付方式改革,探索符合中医药特点的支付方法和管理机制具有重要意义。基于国家医疗保障局推行的按疾病诊断相关分组(Diagnosis Related Groups,DRG)付费和现行医保支付中按项目支付方式,借助博弈理论分析两种支付方式下中医院的诊疗行为策略选择及其影响因素。结果表明,在按项目支付下中医院会选择过度诊疗的行为策略以谋取更多的利润;在DRG支付下,中医院会从过度诊疗的行为向缩减诊疗的行为转化,最终选择缩减诊疗的行为策略以获得更大的利润。这表明,与现行的支付方式相比,DRG支付可以在一定程度上纠正中医医疗机构的过度诊疗行为,遏制医疗资源的浪费,但仍需充分发掘中医药的适宜技术和优势病种,发挥中医药的独特优势,实现中西医之间的优势互补。展开更多
Since medical insurance of our country developed, it is continued to deepen reform and became the basic form of the pcrfcct medical insurance system. However, regional differences still exist. The current medical insu...Since medical insurance of our country developed, it is continued to deepen reform and became the basic form of the pcrfcct medical insurance system. However, regional differences still exist. The current medical insurance system of China＇s urban and rural structure background of two structures of serious, city residents, workers and rural residents is significantly difference in the payment period ,for this question ,the difference between our country will solve the basic medical insurance payment period, the relative level of regulating wages and medical people in our country and develop the medical insurance level, narrow the regional differences, reduce cost problem caused by population flow management, the basic medical insurance system for suggestions to improve the unified and promoting the social and economic level, people＇s medical security level, perfect improvement of physical insurance system of medical insurance according to the long-term sustainable development has a far-reaching significance.展开更多
文摘推动中医药医保支付方式改革,探索符合中医药特点的支付方法和管理机制具有重要意义。基于国家医疗保障局推行的按疾病诊断相关分组(Diagnosis Related Groups,DRG)付费和现行医保支付中按项目支付方式,借助博弈理论分析两种支付方式下中医院的诊疗行为策略选择及其影响因素。结果表明,在按项目支付下中医院会选择过度诊疗的行为策略以谋取更多的利润;在DRG支付下,中医院会从过度诊疗的行为向缩减诊疗的行为转化,最终选择缩减诊疗的行为策略以获得更大的利润。这表明,与现行的支付方式相比,DRG支付可以在一定程度上纠正中医医疗机构的过度诊疗行为,遏制医疗资源的浪费,但仍需充分发掘中医药的适宜技术和优势病种,发挥中医药的独特优势,实现中西医之间的优势互补。
文摘Since medical insurance of our country developed, it is continued to deepen reform and became the basic form of the pcrfcct medical insurance system. However, regional differences still exist. The current medical insurance system of China＇s urban and rural structure background of two structures of serious, city residents, workers and rural residents is significantly difference in the payment period ,for this question ,the difference between our country will solve the basic medical insurance payment period, the relative level of regulating wages and medical people in our country and develop the medical insurance level, narrow the regional differences, reduce cost problem caused by population flow management, the basic medical insurance system for suggestions to improve the unified and promoting the social and economic level, people＇s medical security level, perfect improvement of physical insurance system of medical insurance according to the long-term sustainable development has a far-reaching significance.
