预期支付下的医疗服务提供者行为

Provider behavior under prospective reimbursement

Journal of Health Economics · 1986
被引 717 · 同刊同年前 9%
人大 AABS 3

中文导读

建立模型分析医生在预期支付和成本补偿两种制度下的服务选择,发现预期支付可能导致服务不足,成本补偿则导致过度服务,而混合支付制度在多数情况下更优。

Abstract

This paper develops a model in which physicians choose the level of services to be provided to their patients. We show that if physicians undervalue benefits to patients relative to hospital profits, prospective payment, a system in which hospitals receive a payment dependent on the diagnosis-related group within which a patient falls, can lead to too few services being provided. In contrast, a 'cost-based' reimbursement system is shown to result in too many services being provided. Competition between hospitals for physicians will tend to augment both of these problems. We also examine a mixed reimbursement system, in which hospital reimbursements are paid partly prospectively and partly cost-based. This system is shown under a variety of circumstances to be superior to the other two reimbursement systems by improving the incentives for the efficient level of services, reducing incentives to unnecessarily admit or reclassify patients, and reducing risk to providers.

预付制医生行为混合报销诊断相关分组