中国农村卫生事业管理2025，Vol.45Issue(2)：109-114,6.DOI:10.19955/j.cnki.1005-5916.2025.02.006
基于博弈理论的DRG付费与紧密型县域医共体总额付费政策协同研究
Connection between DRG payment and total payment in compact county-level medical communities from the perspective of game theory
摘要
Abstract
Objective To explore the impact of different synergistic modes of DRG payment and the total payment policies of the compact county-level medical communities on the medical behaviors of medical communi-ties,so as to provide a theoretical basis for optimizing the medical insurance payment mechanism.Methods A dynamic game model of behavior selection strategy between the medical insurance department and medical commu-nities was constructed,and the different collaborative modes of capitation payment and DRG payment("internal payment"and"external payment")and the medical behaviors of medical communities("standardized diagnosis and treatment"and"non-standardized diagnosis and treatment")were used as the game strategy to construct game matrix,and the influencing factors of each game behavior were analyzed.Results The smaller the difference be-tween the annual DRG budget of medical communities under the"internal payment"model and the annual total DRG settlement amount of medical communities under the"external payment"model,the greater the recovery of funds and penalties for violations,the more inclined medical communities were to adopt"standardized diagnosis and treatment".On the other hand,the greater the difference between the medical costs reduced by patient outflow due to non-standardized diagnosis and treatment and the income to be earned due to standardized diagnosis and treatment,the smaller the recovery of funds and penalties for violations by the medical insurance department,the more likely they were to choose the"external payment"model.Conclusions The implementation of the double budget management model of"internal payment"can improve the probability of"standardized diagnosis and treat-ment"in medical communities,which can strengthen the regulatory motivation of medical communities,reduce the supervision cost of the medical insurance department,and improve work efficiency.关键词
紧密型县域医共体/博弈论/支付方式改革/疾病诊断相关分组Key words
Compact county-level medical community/Game theory/Payment reform/Diaqnosis Related Groups分类
医药卫生引用本文复制引用
孙诗洁,李绍华,汤质如,赵林海,卢曼曼..基于博弈理论的DRG付费与紧密型县域医共体总额付费政策协同研究[J].中国农村卫生事业管理,2025,45(2):109-114,6.基金项目
安徽省高等学校省级自然科学研究计划项目(2022AH050711) （2022AH050711）
安徽省医保局委托研究课题(YB2022W03) （YB2022W03）
