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为控制医疗费用,医疗保险预付制在国际范围内广泛应用,中国也在积极探索和试行预付制的改革。但是,医疗机构的道德风险问题是预付制难以成功实施的最大障碍。本文基于医疗机构是风险规避型代理人的假设,构建了一种混合的医疗保险支付方式,当患者费用低于一定数量时,实施按病种付费的预付;当患者的医疗费用超过一定数量时,医疗机构能够能够得到一定比例的成本补贴。本文对混合支付方式的拐点和医疗机构获得的成本补贴比例进行了数值模拟,得出了有意义的政策性建议。
In order to control medical expenses, medical insurance prepaid system is widely used in the international community. China is also actively exploring and piloting the reform of prepaid system. However, the issue of moral hazard in medical institutions is the biggest obstacle to the successful implementation of the prepayment system. Based on the assumption that the medical institution is a risk-averse agent, this paper constructs a hybrid medical insurance payment method. When the patient’s cost falls below a certain amount, the patient-based payment is implemented. When the patient’s medical expenses exceed a certain amount , Medical institutions can be able to get a certain percentage of cost subsidies. This paper numerically simulates the inflexion point of the hybrid payment method and the proportion of the cost subsidy obtained by the medical institutions, and makes meaningful policy recommendations.