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论文编号：	11810
作者编号：	2120182910
上传时间：	2020/6/22 11:13:51
中文题目：	基于DRGs医保支付方式的双向转诊机制演化博弈分析
英文题目：	Evolutionary Game of Two-Way Referral Mechanism Based on Diagnosis Related Groups (DRGs) Payment System
指导老师：	梁峰
中文关键字：	双向转诊；疾病诊断相关分组；医保支付方式；演化博弈
英文关键字：	Two-Way Referral; Diagnosis Related Groups; Medical Insurance Payment; Evolutionary Game
中文摘要：	经过不断发展和改善，我国建立了较为完善的医疗服务体系，但我国人民对医疗服务日益增长的需求与医疗资源总量相对不足的矛盾依然存在，优质医疗资源过于集中的问题依然突出。医疗改革刻不容缓，需要建立起更加合理的医疗制度，对资源更加有效地进行利用与配置。双向转诊制度能够维持医疗秩序，构建有序的就医格局，能够促进优质医疗资源下沉。我国于2006 年开始实施这项制度，取得了一定成果，但双向转诊制度在推行落实中尚有阻碍。按疾病诊断相关分组（DRGs）付费政策是控制医疗费用不合理增长、推进分级诊疗体系建设的重要手段。但我国按DRGs付费政策尚处于试点阶段，仍需探究按DRGs付费对双向转诊的影响，及实施过程中的优化方法，以实现医保支付方式与分级诊疗体系相辅相成、协同打造良好的医疗服务生态。 本文从双向转诊参与主体的转诊决策及其影响因素的角度，以博弈主体的趋利性为前提，用演化博弈模型模拟了各级医疗机构的转诊决策过程。首先分析影响双向转诊的内在因素，建立上下级医院间的两方博弈模型。应用复制动态方程和演化稳定策略的相关理论，分析出不同条件下各级医院的稳定决策。然后在两方博弈模型的基础上加入政府构建三方博弈模型，分析医保支付方式对各级医疗机构选择转诊与否的影响。并介绍了博弈参与者的决策演化方向和各均衡点的稳定状态。并以当前上转容易下转难的困境现实为例，给出不同条件下的博弈结果。最后，通过系统动力学进行参数分析，分析了各因素对博弈主体的决策影响，得出如下结论：医疗定价合适合理、提高转诊补偿、提高患者对医疗服务质量的预期、增加合作效益增量，将使得各医疗机构更偏向于作出转诊决策；严格控制按DRGs付费政策的规范性，规避医疗不足风险，提高患者效益增量，DRGs分组定价合理，能够充分发挥按DRGs付费对双向转诊的促进作用，引导各级医院形成双向转诊合作。
英文摘要：	A relatively complete medical service system has been established in China through the continuous development and improvement. However, it sometimes happens that the medical resources could be overwhelmed by the increasing demand for medical service, while the excessive concentration of high-quality medical resources remains a prominent problem. Thus, health care reform is urgently needed to utilize and configure the resources more effectively, by establishing a more rational medical system that satisfies the people's needs. The two-way referral system, which is adopted by China since 2006, is believed to be effective in building an orderly pattern of medical treatment and promoting the fair distribution of quality medical resources. Nevertheless, there are still obstacles in the implementation of this system. The payment policy based on Diagnosis Related Groups (DRGs) is important to control the irrational medical expenses and promote the construction of a hierarchical diagnosis and treatment system. In China, the DRGs-based payment policy is still in the pilot stage. Its impact on two-way referrals and optimization methods in the implementation process need to be explored, to combine advantages of DRGs-based payment and Graded diagnosis and treatment, which will achieve the collaborative contribution to a good medical service ecosystem. Taking the profitability of medical institutions as a premise, an evolutionary game model was established to simulate the referral decision-making process of medical institutions at each level, from the perspective of participants decision-making and its influencing factors of the two-way referral system. Initially, a two-party game model between lower and higher hospitals was established after analyzing the internal factors of two-way referrals. The theory of replicator dynamic equation and evolutionarily stable strategy is used to analyze the decisions of hospitals under different conditions. Based on this model, the government was then added to build a three-party game model to analyze the impact of medical insurance payment methods on referral decisions of medical institutions. The evolution direction of game participants' decisions and the stable state of each point are introduced. Taking the current dilemma of upward referral easily but downward referral difficultly as an example, the game results under different conditions are given. The impact of parameters on decision making was analyzed by system dynamics and the following conclusions could be reached: reasonable pricing, improving referral compensation, increasing patient expectation of medical service quality, and increasing cooperation benefit will make medical institutions more inclined to make referral decisions. By controlling the standardization of DRGs-based payment policies strictly, avoiding the risk of inadequate medical treatment, increasing the patient's benefit, and reasonable pricing based on DRGs, can achieve the promotion of DRGs-based payment to two-way referrals, and guide hospitals to form two-way referral cooperation.
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