Reimbursement gap, patient behavior and medical expenses——A three-stage dynamic game analyses
GAN Xiao-qing1,2, YOU Ming-xiang2, HU Kai1,3
1. Business School, Jiujiang University, Jiujiang 332005, China; 2. School of Economics and Management, Nanchang University, Nanchang 330031, China; 3. Development & Research Center of the State Post Bureau, Beijing 100868, China
Abstract：Universal medical insurance system had been preliminary established in China, individual self-paying medical expense ratio decreased from 52.2% in 2005 to 34.9% in 2011. But the total health expenses of the whole society and the amount of the patients' average self-paying were in substantial increase; At the same time, the phenomenon of big hospitals overwhelmed and grass-roots hospital empty still existed. Under this background, based on the medical service system composed of superior hospitals, subordinate hospital, medical insurance fund, and patients, took the superior and subordinate hospital treatable disease as assumptions, built three-stage dynamic game model, this paper analyzed the behavior of each participant and the numerical simulation, so we got the conclusion: The superior hospital reimbursement ratio rose, which could cause the number of patients in superior hospital increase, and the drop in the population of subordinate hospital, and made the superior hospital medical service price, the whole society total medical expense and patients self-pay total costs rose; Hospital quality gap could also lead to total medical expense rose of the whole society; Only the reasonable use of medical insurance policy could improve classification system, reasonable divergence patients, and reduce the medical service quality gap between the superior and the subordinate hospital, establish a more scientific system of medical service, which really relieved patients' burden.
甘筱青, 尤铭祥, 胡凯. 医保报销比例差距、患者行为选择与医疗费用的关系研究——基于三阶段动态博弈模型的分析[J]. 系统工程理论与实践, 2014, 34(11): 2974-2983.
GAN Xiao-qing, YOU Ming-xiang, HU Kai. Reimbursement gap, patient behavior and medical expenses——A three-stage dynamic game analyses. Systems Engineering - Theory & Practice, 2014, 34(11): 2974-2983.
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2014, Vol. 34 
