药占比管制下过度医疗行为多阶段动态演化研究

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中文摘要：继取消用药加成措施以防范医生过度用药后，过度检查、过度治疗等问题日益严重。基于此，构建了药占比管制下患者、医生、院方等主体参与的医患行为多阶段动态演化博弈模型，探讨了医患三方参与主体的行为策略演化。研究结果显示:(1)非药品费用考核与激励是引发医生过度检查、过度治疗等问题的重要原因，患者申诉渠道的不畅通更是助长了医生过度检查和过度治疗问题;(2)医患两方博弈过程中，药占比管制并不总是有利于抑制过度医疗问题，而在院方参与的医患三方博弈过程中，药占比管制可以抑制过度医疗问题，但前提是患者拥有畅通的申诉渠道;(3)医生用药占比奖励和惩罚措施对系统演化的影响呈现异质性，当药占比参考值较小时，院方更应该对超标准执行药占比管制文件的医生采取奖励措施，当药占比参考值较大时，院方更应该对超标准用药的医生采取惩罚措施;(4)医生倾向于为医治成本较低的患者提供过度医疗方案，而倾向于为轻症患者提供合理医疗方案，且医治成本较低的患者往往只能被迫接受，因此院方应利用有限的审查成本重点展开对医治成本低的医疗方案的审查;(5)患者过高的申诉成本降低了患者接受医生提供的医疗方案的意愿，亦无益于基层首诊的推广与普及，因此院方应建立过度医疗惩罚转移支付机制，培养医患间信任环境。

外文标题：Multi-stage Dynamic Evolution of Over-treatment Behavior under Drug-proportion Regulation

外文摘要：Over-treatment is one of the key issues in China's medical reform.Following the abolition of medica-tion bonus measures to prevent doctors from overusing medications,problems such as over-examination and over-treatment have become increasingly serious.A multi-stage dynamic evolution game model of doctor-patient behavior is constructed under the control of drug ratio,and the evolution of the behavior strategy of the three participants of doctors and patients is discussed by replicating the Jacobi matrix and numerical experiment simulation of the dynamic system.The results are as follows.(1)The assessment and incentive of doctors'non-drug expenses by the hospital is an important reason for the problems of excessive examination and over-treatment of doctors.The poor channels for patient complaints have contributed to the problem of over-examination and over-treatment by doctors.(2)In the two-way game between doctors and patients without hospital participation,drug proportion control is not always conducive to curb excessive medical problems,but in the three-way game between doctors and patients with hospital participation and patients having channels to review medical plans,drug proportion control is always conducive to curb excessive medical problems.(3)When the reference value of drug proportion is small,the hospital should take incentive measures for doctors who exceed the standard drug proportion control documents,and when the reference value of drug proportion is large,the hospital should take punitive measures against doctors who use drugs beyond the standard.(4)Mild patients and patients with low treatment cost will be treated differently by doctors.Doctors tend to provide excessive medical schemes for patients with low treatment cost,but tend to provide reasonable medical schemes for mild patients,and patients with low treatment cost can only be forced to accept it.Therefore,The hospital should use the limited review cost to focus on the review of medical plans for patients with low treatment cost but serious diseases.(5)The high complaint cost of patients reduces the willingness of patients to accept the medical scheme provided by doctors,and is not conducive to the promotion and popularization of the first diagnosis at the grass-roots level.Therefore,the hospital should actively review the medical scheme provided by doctors,and establish a transfer payment mechanism for excessive medical punishment to compensate patients for their losses,so as to realize mutual trust between doctors and patients.

外文关键词：

drug-proportion regulationover-treatmenttripartite evolutionary gamemulti-stage dynamic gamemechanism of transfer payment

作者：

孙向彦、曲薪池

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作者单位：

山东工商学院管理科学与工程学院,山东烟台 264005

关键词：

药占比管制过度医疗三方演化博弈多阶段动态转移支付机制

基金：

国家自然科学基金项目国家自然科学基金项目山东高等学校哲学社会科学项目山东省自然科学基金项目山东省自然科学基金项目山东工商学院特色研究专项山东工商学院科研启动费山东工商学院科研启动费

项目编号：

71904107721021292024ZSMS312ZR2023QG032ZR2023QG0442023TSXM012BS202204BS202205

出版年：

2024

DOI：

10.16381/j.cnki.issn1003-207x.2022.1780

中国管理科学

中国优选法统筹法与经济数学研究会中科院科技政策与管理科学研究所

中国管理科学

CSTPCDCSSCICHSSCD北大核心

影响因子：1.938

ISSN：1003-207X

年,卷(期)：2024.32(8)