| Citation: |
CHEN Kunyu, TAO Qunshan, DING Zili. Analysis on the Influence of Different Medical Insurance Payment on the Diagnosis and Treatment Behavior of Traditional Chinese Medicine Hospitals from the Perspective of Game[J]. Journal of Nanjing University of traditional Chinese Medicine(Social Science Edition), 2024, 25(4): 231-237, 269. DOI: 10.20060/j.cnki.ISSN1009-3222.2024.0231
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In order to promote the reform of the payment methods of traditional Chinese medicine (TCM) medical insurance, we explore the payment methods and management mechanisms in line with the field of TCM. Based on the diagnosis related groups (DRG) payment and the current payment by project in medical insurance payment implemented by the National Healthcare Security Administration, this paper analyzes the selection of diagnosis and treatment behavior strategies and the influencing factors of traditional Chinese medicine hospitals under the two payment methods with the help of game theory. It is found that under the payment by project, TCM hospitals choose the behavioral strategy of excessive diagnosis and treatment to make more profits; under DRG payment, TCM hospitals change the behavior of transforming from excessive diagnosis and treatment to the behavior of reducing diagnosis and treatment, and finally choose the behavioral strategy of reducing diagnosis and treatment to obtain greater profits. The research shows that, compared with the current payment methods, DRG payment can correct the excessive diagnosis and treatment behavior of TCM medical institutions and curb the waste of medical resources; however, it is still necessary to fully explore the appropriate technology and dominant diseases of TCM, give play to the unique advantages of TCM, and realize the complementary advantages between Chinese and Western medicine.
| [1] |
CHANG W F, YAN X Y, LING H, et al. A study of the types and manifestations of physicians' unintended behaviors in the DRG payment system[J]. Front Public Health, 2023, 11: 1141981. DOI: 10.3389/fpubh.2023.1141981
|
| [2] |
张立强, 李强, 李欣芳, 等. 价值视角下体现中医元素的支付方式改革实践与思考[J]. 中国卫生经济, 2023, 42(2): 1-5. https://www.cnki.com.cn/Article/CJFDTOTAL-WEIJ202302001.htm
|
| [3] |
国务院办公厅关于印发深化医药卫生体制改革2019年重点工作任务的通知[J]. 中华人民共和国国务院公报, 2019(17): 18-22.
|
| [4] |
国务院办公厅印发《关于推动公立医院高质量发展的意见》[J]. 卫生经济研究, 2021, 38(7): 7.
|
| [5] |
陈明波, 梁沛枫. 中医医院开展DRG支付方式改革现状与思考[J]. 中国医院, 2024, 28(4): 14-17. DOI: 10.3969/j.issn.1671-9174.2024.04.003
|
| [6] |
徐婧. 国家医疗保障局、国家中医药管理局联合发文推动医保支持中医药传承创新发展[J]. 中医药管理杂志, 2022, 30(1): 176. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYG202201153.htm
|
| [7] |
鲁志鸿, 孙经杰, 李友卫, 等. DIP支付方式改革对山东省县级中医医院住院服务的影响研究: 基于DID的实证研究[J]. 中国卫生经济, 2024, 43(4): 64-67. https://www.cnki.com.cn/Article/CJFDTOTAL-WEIJ202404014.htm
|
| [8] |
杨永生, 肖梦熊, 陈珞珈, 等. 以桡骨远端骨折为中医优势病种的历史成本费用结构分析[J]. 中国卫生经济, 2020, 39(12): 66-68. https://www.cnki.com.cn/Article/CJFDTOTAL-WEIJ202012020.htm
|
| [9] |
周绿林, 陈志远, 白焓斌, 等. 医保信用无感支付中多元利益主体关系: 从合作博弈到激励相容[J]. 中国卫生经济, 2024, 43(6): 40-43. https://www.cnki.com.cn/Article/CJFDTOTAL-WEIJ202406009.htm
|
| [10] |
于保荣. 按病例支付及医疗服务支付方式改革的实现条件: 从DRGs、按病种付费、点数法付费及临床路径谈起[J]. 卫生经济研究, 2018(9): 16-18. https://www.cnki.com.cn/Article/CJFDTOTAL-WSJJ201809006.htm
|
| [11] |
曹珍, 管仲军. 我国医疗服务的质量观及医保支付方式改革背景下的质量评价探讨[J]. 中国卫生经济, 2024, 43(1): 21-25. https://www.cnki.com.cn/Article/CJFDTOTAL-WEIJ202401006.htm
|
| [12] |
岳谦, 刘莹莹, 伍志庭, 等. 我国几种医保付费方式的特点和问题研究[J]. 赣南医学院学报, 2023, 43(2): 188-192. https://www.cnki.com.cn/Article/CJFDTOTAL-GNYX202302013.htm
|
| [13] |
陈明波, 梁沛枫. DRG支付方式改革对公立医院高质量发展的影响及对策分析[J]. 中国医院, 2024, 28(1): 12-14. DOI: 10.3969/j.issn.1671-9174.2024.01.003
|
| [14] |
杨勇, 满晓玮, 尹学珺, 等. 医疗保险支付方式改革下中医按病种付费的可行性与问题研究[J]. 中医药管理杂志, 2018, 26(24): 1-4, 40. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYG201824002.htm
|
| [15] |
潘佳佳, 王长青, 张文良, 等. 价值医疗视角下中医医院DRG综合运营管理方案探索[J]. 中国卫生经济, 2021, 40(6): 77-81. https://www.cnki.com.cn/Article/CJFDTOTAL-WEIJ202106022.htm
|
| [16] |
方金鸣, 陶红兵. 基于博弈模型的DRG制度对医院分解收费行为的影响[J]. 中国医院统计, 2023, 30(1): 43-47. https://www.cnki.com.cn/Article/CJFDTOTAL-JTYY202301008.htm
|
| [17] |
张婉莹, 陶群山, 魏骅. 两种医保支付方式下医保利益主体的博弈机制分析[J]. 广东药科大学学报, 2022, 38(6): 115-120. https://www.cnki.com.cn/Article/CJFDTOTAL-GDYX202206019.htm
|
| [18] |
马广斌, 尹文强, 赵兹旋, 等. 基于演化博弈理论的医疗机构与医保行政部门关于欺诈骗保行为的策略分析[J]. 中国卫生事业管理, 2020, 37(11): 820-822, 826. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWSG202011008.htm
|
| [19] |
刘黎明, 邱佳瑜, 宣天惠, 等. 中医优势病种在综合医院和中医类医院住院费用对比分析[J]. 中国卫生经济, 2022, 41(7): 24-27. https://www.cnki.com.cn/Article/CJFDTOTAL-WEIJ202207007.htm
|
| [20] |
肖颖. 公立医院成本核算的影响因素及改进探索[J]. 中国卫生经济, 2023, 42(3): 91-93, 96. https://www.cnki.com.cn/Article/CJFDTOTAL-WEIJ202303022.htm
|
| [21] |
林坤河, 姚轶凡, 熊英贝, 等. DRG收付费一体化改革影响机制分析: 以福建省泉州市和三明市为例[J]. 中国卫生政策研究, 2023, 9(10): 49-55. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWZ202310007.htm
|
| [22] |
张小娟. 基于门诊和住院保障的视角重构医保待遇保障组合[J]. 中国卫生政策研究, 2021, 14(5): 21-27. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWZ202105005.htm
|
| [23] |
何庆红, 赵绍阳, 刘国恩. 医药分开改革对医疗费用和医疗质量的影响[J]. 世界经济, 2021, 44(12): 178-200. https://www.cnki.com.cn/Article/CJFDTOTAL-SJJJ202112008.htm
|
| [24] |
杨越, 顾伟, 吕奕鹏, 等. 医院医用耗材SPD供应链配送商风险管理研究[J]. 中国医院, 2024, 28(2): 9-12. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYU202402003.htm
|
| [25] |
朱丽云, 朱亚洲, 肖富群, 等. 中医药"非对称共摊"机制的我国现代化医保治理探讨[J]. 中国卫生经济, 2024, 43(5): 23-27, 33. https://www.cnki.com.cn/Article/CJFDTOTAL-WEIJ202405006.htm
|
| [26] |
张馨元, 韩优莉, 薄云鹊, 等. 由后付制向预付制转变对医生行为影响的实验研究[J]. 中国卫生经济, 2020, 39(4): 28-32. https://www.cnki.com.cn/Article/CJFDTOTAL-WEIJ202004010.htm
|
| [27] |
李敏强, 彭颖, 程明, 等. 国外DRGs定价与支付体系对我国医保支付方式改革启示[J]. 中国医院, 2021, 25(1): 58-61. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYU202101020.htm
|
| [28] |
丁瑞琳, 颜建周, 欧阳沁, 等. 定点零售药店纳入门诊统筹管理政策对利益相关者的影响分析[J]. 中国卫生政策研究, 2024, 17(3): 17-23. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWZ202403003.htm
|
| [29] |
王志伟. 试论中医医院特殊性对其医保支付方式选择的影响[J]. 社会保障研究, 2017(2): 77-81. https://www.cnki.com.cn/Article/CJFDTOTAL-SHBY201702009.htm
|
| [30] |
方金鸣, 陶红兵. DRG制度对医保监督医院医疗资源消耗行为的博弈分析[J]. 现代医院管理, 2023, 21(6): 71-75. https://www.cnki.com.cn/Article/CJFDTOTAL-GLYY202306020.htm
|
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