Influence of DRG system on hospital charge decomposition behavior based on game model
Fang Jinming1,2，Tao Hongbing2
1 Wuhan Fourth Hospital, Wuhan 430033, China;
2 School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Abstract： Objective To analyze the influence of DRG system on hospital charge decomposition with the game model.Methods By analyzing the definition of decomposition charge, the behavior strategy of the game subjects, and the structure of hospital diagnosis and treatment expenses, this paper constructs the supervision game models of medical insurance on the decomposition charge behavior of hospitals under the fee-for-service payment and the DRG payment respectively, and obtains the equilibrium solution of the game model.Results Under Nash equilibrium, the probability of hospital charge decomposition is equal under the fee-for-service payment and the DRG payment, but its essence is different, because under the DRG payment, the probability of medical insurance inspection is less than that under fee-for-service payment. If the medical insurance maintains the original inspection probability, the probability of hospital charge decomposition will decrease.Conclusion The reform of DRG system leads to the reduction of the motivation for hospitals to carry out decomposition charges, and reduces the supervision pressure of medical insurance on hospital decomposition charges. The insurance managements can reduce the administrative investment and appropriately shift the focus of supervision. In addition, strengthening the education of medical ethics, increasing the coverage of supervision and speeding up the process of scientific pricing can also reduce the behavior of hospital charge decomposition.
方金鸣，陶红兵. 基于博弈模型的DRG制度对医院分解收费行为的影响[J]. 中国医院统计, 2023, 30(1): 43-47.
Fang Jinming, Tao Hongbing. Influence of DRG system on hospital charge decomposition behavior based on game model. journal1, 2023, 30(1): 43-47.
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