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The Game Analysis of Related Subjects of Medical Insurance Payment

Author: JiangPing
Tutor: GuoWenChen
School: Dalian University of Technology
Course: Social Security
Keywords: Medical Insurance Related entities Game Analysis
CLC: F224.32
Type: Master's thesis
Year: 2010
Downloads: 328
Quote: 0
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Abstract


In the context of building a harmonious society era, universal access to basic medical insurance, medical services, is an important task of building a harmonious society. And increase the economic burden and improve the medical insurance system for the mitigation of the people due to illness, and to protect and improve the quality of labor, to promote economic and social development and social stability can play an extremely important role. The current basic medical insurance system, the rapid growth of health care costs, the economic burden in patients, the contradiction between medical service providers and patients has become the focus of social contradictions. To achieve the smooth running and the sustainable development of China's social medical insurance, to resolve the medical expenses rapid growth and has become essential contradiction between doctors and patients. Decision on pay for medical insurance costs related entities - health insurance agencies, medical service providers, as well as insured patients behavior is the key to solving this problem, and also has a significant impact on this goal for medical services, not only the relationship between the national access to medical insurance level, the sustainability of the security of the medical insurance fund, and the relationship of social equity. In this paper, the theoretical analysis and case analysis of a combination of methods, from the point of view of revenue to pay for medical insurance costs related body twenty-two, Game analysis, to explore the impact of the game equilibrium factors. The Boyi results: (1) health insurance agencies and medical service providers, (P1, P2) in the course of the game between health care institutions and medical insurance institutions Nash equilibrium point. I.e. medical institutions to the probability of P1 (1-Z / (m [a (RE) E])) to comply with the protocol, and the health insurance agency by P2 (E / (m [E a (RE)])) probability review. Moreover, under equilibrium conditions, the hospital comply with the agreement probability P1 with a review of the cost of medical insurance agencies (Z) negative correlation, the probability of success in the insurance agencies review (m), the punishment intensity coefficient (α) is related. Probability of P2 and medical services to non-compliance with the agreement to obtain additional revenue (E) is related insurance agencies to review, and the review of the medical insurance institutions probability of success (m), as well as punishment intensity coefficient (α) negative correlation. (2) Game Analysis between medical service providers and insured patients, (P3, P4) are both Nash equilibrium point. When the sentinel medical services institutions P3 (1 - (C2) / (m2X)) provide reasonable clinic patients traced P4 ((R2 R3) / (m2X)) probability, to achieve a balanced game. Probability under equilibrium conditions, designated medical service agencies clinics reasonable probability P3 patients tracing costs (C2) negative correlation with the patient tracing successfully obtained compensation (m2), compensation (X) is a positive correlation. The the patient tracing the probability P4, medical services Insitutitons income of positively related to compensation and tracing probability (m2), and the amount of compensation (X) negative correlation. Infinitely repeated game analysis of the game between doctors and patients, to prove after two unlimited game, doctors and patients can achieve a non-zero-sum cooperative game. When doctors to provide reasonable clinic patients to trust a doctor action, you can achieve a balanced portfolio and achieve optimal overall interests of doctors and patients. And in game analysis process, the information and the credibility of the problem is a key factor affecting Equilibrium. During the analysis, the patient and the doctor repeated game equilibrium by factors of information. Information factors is a crucial factor to change the status of the game. Good reputation helps to increase mutual trust, reduce the cost of promoting cooperation, and cooperation (3) patients and medical insurance agencies game Nash equilibrium (P5, P6). That patients P5 (C / (a ??(ME)-E)), the probability of selection potentially fraudulent, and medical insurance institutions by P6 (E / ((ME) E)) the probability of review. As can be seen from the game balanced results, both by the patient gains M game equilibrium results, additional revenue E review of the cost of health insurance institutions (C), and the penalty coefficient (α). The patients Pianbao probability P5 and medical insurance agencies to review costs (C), additional receipts (E) is related punishment intensity coefficient (α) negative correlation with the insurance agencies. Examine the probability of health insurance agencies the P6 and patients Pianbao additional revenue E positive correlation, negative correlation with medical insurance agencies punishment intensity coefficient (α). Finally, medical insurance institutions, health care institutions and patient behavior decision-influencing factors, the conditions put forward to improve the game, reasonable proposals to promote the development of cooperative game direction. Such as: perfect medical insurance to pay way; implementation of basic health services project and drugs of a unified pricing system, medical separation; establishment of the credit evaluation mechanism for hospitals and health services information disclosure system; reasonable incentive mechanism; expand health insurance coverage; improve the cost of self- payment system; intensify propaganda to play the role of social supervision; create and take full advantage of the medical services information systems and computer network information platform; strengthen the system and intensify inspection and punishment.

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CLC: > Economic > Economic planning and management > Economic calculation, economic and mathematical methods > Economic and mathematical methods > Operations Research in the economy > Game Theory
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