摘要
药品零加成政策在某种程度上降低了药品费用,但仅切断了医疗机构从药品中获利的途径,轻视了过度医疗对患者医疗费用的影响。笔者从博弈论视角,构建和分析医务人员与医保管理机构的博弈模型,得出医保管理成本、处罚力度、社会效益是影响监管成果的最有效因素。结合某市医保智能审核政策进行分析,发现该政策能有效降低医保管理成本、保证处罚落实、规范医疗行为,但我国卫生事业发展进度无法满足审核规则所需的客观条件、医疗行为无法满足审核规则所需的普遍适应性,进而提出相应对策。
The Zero-Markup Medicine Policy only cuts the way for medical institutions to profit from medicine,and despises the impact of over medical treatment on medical expenses of patients. We use game theory to build and analyze the game model between medical staff and medical insurance management institutions,and draw the conclusion that the most effective factors affecting the regulatory results are the cost of medical insurance management,the intensity of punishment and the social benefits. Combined with the policy of medical insurance intelligent audit in a city,it is found that the policy can effectively reduce the cost of medical insurance management,ensure the implementation of penalty and standardize the medical behavior. But there are still some shortcomings of the policy,such as increasing the medical staff＇s non-medical work,the defects of the audit rules and procedures will affect the interests of medical staff and bring health risks of the patient.
作者
邱胜
李浩
吴金婕
Qiu Sheng(Department of Medical Insurance Management,Union Hospital Affiliated to Tongji Medical College,HUST,Wuhan,43002)
出处
《医学与社会》
北大核心
2018年第7期10-13,共4页
Medicine and Society
关键词
药品零加成
过度医疗
智能审核
博弈论
Zero-Markup Medicine Policy
Over Medical Treatment
Intelligent Audit
Game Theory
