差异化医保下的双层医疗系统定价方案分析

在差异化医保的背景下,研究存在政府引导的双层医疗系统定价问题。构建独立决策和医联体共同决策的定价模型,通过对比两种决策方案下的系统成员收益来制定最优定价策略,同时探讨医院间治疗水平差距对于系统收益的影响。结果表明:提高社区医院的治疗水平不一定使患者收益增加,提升三甲医院的医疗能力才能使医疗机构收益及患者收益提升;仅当两医院间治疗差距较大时才能形成医联体,但却不一定对系统成员有利;同时,医联体模式“降价不提质”,大多数情况下独立定价反而是最优的定价方案。

Pricing analysis of two-tier public hospital system under differentiated medical insurance

To examine the pricing decision-making in the two-tier medical system under the guidance of governments in the context of differentiated medical insurance, the independent decision-making pricing model and the medical cooperation joint decision-making model are constructed. The optimal pricing strategy is formulated by comparing the benefits of the system members under the two schemes, and the impact of the treatment level of different hospitals is studied on system benefits. The results show the following conclusions. Improving the treatment level of the community hospitals will or will not increase the benefits of the patients, while improving the treatment level of top-tier hospitals can significantly increase both the benefits of patients and the income of the hospitals. Only when there is a big gap in the treatment levels between two hospitals can the two hospitals form a medical cooperation, but the cooperation may not be beneficial to each member of the system. The medical cooperation does reduce the treatment price but does not improve the quality. Furthermore, the independent pricing model is the optimal pricing scheme in most cases.