基于博弈理论的DRGs支付方式下医疗机构与医保部门行为分析

Behavior Analysis of Medical Institution and Medical Insurance Department under DRGs Payment Mode Based on Game Theory

摘要: 近年来，为提升医疗服务资源的使用效率和公平性，我国一直在探索新的医疗支付方式，逐步发展出基于DRGs付费的混合支付方式。这种支付方式在一定程度上能够提高医疗服务能力，使医疗质量和管理水平有所上升。本文从博弈论的视角，构建了医保部门与医疗机构在DRGs制度下的博弈模型，得出医疗机构所获额外收入、医保机构的监管成本、罚金高低是博弈均衡的影响因素。结合博弈结果提出加大处罚力度、培养优质的医疗队伍、完善智能医疗审核系统、加强对医疗机构监督的对策，促进DRGs支付方式良性发展并使医疗保障基金能够得到更高效地利用，更好地构建一个高效的医疗支付方式。

Abstract: In recent years, in order to improve the use efficiency and fairness of medical service resources, China has been exploring new medical payment methods, and gradually developed a mixed payment method based on DRGs payment. This kind of payment method can improve the medical service capacity to a certain extent, so that the medical quality and management level have been improved. From the perspective of game theory, this paper constructs a game model between medical insurance department and medical institution under DRGs system, and concludes that the additional income of medical institution, supervision cost of medical insurance institution and fine level are the influencing factors of game equilibrium. Combined with the results of the game, this paper puts forward the countermeasures of increasing punishment, cultivating high-quality medical teams, improving the intelligent medical audit system and strengthening the supervision of medical institutions, so as to promote the benign development of DRGs payment mode and make the medical security fund be used more efficiently, so as to better build an efficient medical payment mode.