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OA

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.