摘要
目的通过分析医生是否做出可信行为来研究患者就医应对策略问题,从而达到最优市场类型的协调。方法构建医生和患者间信号博弈模型,研究患者根据医生是否值得可信从而采取就医策略的动态过程,分析实现医患双方动态博弈精炼贝叶斯均衡最优解的市场条件。结果市场部分成功的混同均衡的条件是:当r_1>c_1-w_1时,医患双方策略组合和判断为[(m_2,m_2);(a_1,a_1);(p_左,p_右)];其中p_左=(p,1-p),0≤p≤1;p_右=(q,1-q),c_2/c_2+v≤q=α≤1;市场完全成功的分离均衡的条件是:当r_1>c_1-w>0,医患双方策略组合和判断为[(m_2,m_1);(a_1,a_2);(p_左,p_右)],其中p_左=(p,1-p),p=0;p_右=(q,1-q),q=1;市场完全失败的混同均衡的条件是:当r_1≥c_1,医患双方策略组合和判断为[(m_2,m_2);(a_2,a_2);(p_左,p_右)];其中p_左=(p,1-p),0≤p<1;p_右=(q,1-q),0≤q=α<c_2/c_2+v。结论医生可信行为成功反映医生真实类型的精炼贝叶斯均衡在于参数w、r_1和c_1之间的关系,在混同均衡中患者对于医生的类型的信念α,也满足与参数c_2、v的一定关系。并且市场效率随着伪装成本的降低、诊疗收入逐渐增大和不可信行为造成的损失的增加而降低。当只有存在足够高的伪装成本、控制诊疗收入和减少不可信行为产生的损失三个前提下,信任信号才可能发挥真实作用,才能实现最优市场类型的协调。政府可通过加大医疗监管力度,提高伪装成本,控制诊疗收入以及构建医生声誉奖惩机制等规范医生行为政策,来实现医患关系改善。
Objective This study aims to study coping strategies a patient would make according to whether a doctor conduct trustworthy behaviors. Methods A signal game model is constructed to analyze the trust-building process when a patient seeing the physician. Results When r1 〉 c1 - w1, it achieves a market partially success of pooling equilibrium. The combination of strategy and the judgment of the patients and the doctors is： [（m2,m2）;（a1,a1）;（p左,p右）]; p左=（p,1-p）,0≤p≤1;p右=（q,1-q）,c2/c2＋v≤q=α≤1,where r1〉c1-w〉0 the combination of strategy and the judgment is：[（m2,m1）;（a1,a2）;（p左,p右）],其中p左=（p,1-p）,p=0;p右=（q,1-q）,q=1, when r1≥c1;When r1≥c1,it achieves a market total failure of pooling equilibrium. The combination of strategy and the judgment is ： [（m2,m2）;（a2,a2）;（p左,p右）];p左=（p,1-p）,0≤p〈1;p右=（q,1-q）,0≤q=α〈c2/c2＋v . Conclusions The perfect bayesian equilibrium is determined not only by the parameter ：w,r1c1 ,α ,but also by c2 and v. And the market efficiency decreases with the decrease of disguised cost, the increase of diagnosis and treatment income and loss resulting from untrustworthy behaviors,that is, trustworthy signal may play a real role only in the premise of three higher or lower premieres, so as to a- chieve the eoordination of optimal market type. Such suggestion as strengthening medical supervision, improving the dis- guised cost, controlling the diagnosis and treatment of income and building physician reputation rewards and punishment mechanism was discussed to better relationship between a physician and a patient.
出处
《中华全科医学》
2015年第11期1733-1735,1741,共4页
Chinese Journal of General Practice
基金
国家自然科学基金(71373159)
教育部人文社会科学规划基金项目(13YJAZH003)
2015年上海市卫计委科研课题(20144Y0117)
关键词
可信行为
信号博弈
伪装成本
诊疗收入
精炼贝叶斯均衡
Trustworthy behaviors
Signal game theory
Disguised cost
Diagnosis and treatment income
Perfect Bayesian equilibrium
