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DRG付费改革背景下我国除外支付政策的演化博弈与仿真分析
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| 篇名： | DRG付费改革背景下我国除外支付政策的演化博弈与仿真分析 |
| TITLE： | Evolutionary game and simulation analysis of add-on payment policy under DRG payment reform in China |
| 摘要： | 目的 为我国建立并优化除外支付政策提供参考。方法构建医保、医疗机构的两方演化博弈模型，并进行仿真模拟，分析按疾病诊断相关分组（DRG）付费改革背景下医保部门建立除外支付政策与否、补偿比例、新技术的成本和增量效用等因素对医疗机构创新技术使用的影响。结果与结论除外支付政策可有效激励新技术的使用，但同时会带来新技术滥用的风险。除外支付政策的补偿比例、新技术单价、新技术效用改善带来的成本节约以及新技术治疗的增量效用均会对演化博弈的均衡状态产生影响，甚至翻转均衡状态。建议优化除外支付范围的遴选标准，激励创新技术使用的同时控制其滥用风险，并基于统筹地区医保基金结余水平合理采用单独支付或补充支付的模式，同时建立定期调整机制，做好除外支付与DRG支付体系的衔接。 |
| ABSTRACT： | OBJECTIVE To provide reference for the establishment and optimization of add-on payment policy in China. METHODS The two-party evolutionary game model was constructed， involving medical insurance and medical institutions，and simulation experiments were conducted. The effects of factors such as whether the establishment of add-on payment policy by the medical insurance department， the compensation ratio， and the cost and incremental utility of new technology on the adoption of innovative technologies by medical institutions were analyzed under the backdrop of the reform of the diagnosis-related groups （DRG） payment system. RESULTS & CONCLUSIONS The add-on payment policy can effectively incentivize the utilization of innovative technologies， but it also carries the risk of overuse or misuse of new technologies. The compensation ratio， unit price of new technology， and cost savings derived from the improved effectiveness of new technologies， as well as the incremental utility of new technology， will all affect the equilibrium state of the evolutionary game， potentially even reversing it. It is recommended to optimize the selection criteria for the scope of add-on payment， so as to incentivize the use of innovative technologies while controlling the risk of their misuse. Additionally， a reasonable approach should be taken to adopt either standalone payment or supplementary payment models based on the surplus level of medical insurance funds in the coordinated regions. Meanwhile， a regular adjustment mechanism should be established to ensure smooth integration between the add-on payment and the DRG payment system. |
| 期刊： | 2025年第36卷第22期 |
| 作者： | 陈烨；李佳明；阳丰鸿；李伟 |
| AUTHORS： | CHEN Ye，LI Jiaming，YANG Fenghong，LI Wei |
| 关键字： | 除外支付；DRG付费；创新技术；演化博弈；医保支付；影响因素 |
| KEYWORDS： | add-on payment； DRG payment； innovative technology； evolutionary game； medical insurance payment； |
| 阅读数： | 1 次 |
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