Game Analysis and Improvement of the Medical Expenses Payment
Fee for Service is a widely used way of medical expenses payment. However, this kind of payment often stimulates the excessive medical services. This paper reveals the mechanism of excessive medical service through economic game theory. It is difficult to
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Game Analysis and Improvement of the Medical Expenses Payment Fang Qing, Li Luo, Ming Zhao and Qunrong Ren
Abstract Fee for Service is a widely used way of medical expenses payment. However, this kind of payment often stimulates the excessive medical services. This paper reveals the mechanism of excessive medical service through economic game theory. It is difficult to control health care cost under a single payment mode. Under the framework of new rural cooperative medical schemes, this paper presents a mixed payment and analyzes the game between Medical Insurance and hospital. Results indicate that choosing a mixed payment strategy according to certain probability distribution can always achieve the Pareto equilibrium solution of resource allocation and can also be helpful to control the excessive growth of medical expenses. Keywords Medical expenses payment payment
· Game theory · Fee for service · Mixed
4.1 Introduction Social medical insurance, which is an important part of the country’s social security system, has a pivotal position to maintain social stability and has played a huge role in the protection of workers’ health and resist the risk of disease and so on. Since the implementation of the basic medical insurance system for urban employees in 1998, our country mainly focuses on expanding coverage, improving the level of F. Qing (B) · L. Luo · Q. Ren Business School, Sichuan University, Chengdu 610064, Peolple’s Republic of China e-mail: [email protected] L. Luo e-mail: [email protected] M. Zhao The Hong Kong Polytechnic University, Kowloon, Hong Kong J. Xu et al. (eds.), Proceedings of the Eighth International Conference on Management Science and Engineering Management, Advances in Intelligent Systems and Computing 280, DOI: 10.1007/978-3-642-55182-6_4, © Springer-Verlag Berlin Heidelberg 2014
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compensation and strengthening service management. With universal coverage of basic medical security system, the control of the medical treatment cost is more and more important. At present, although free medical care security system has been abandoned in China, those phenomena-such as sharp raise of health care costs, the shortage and waste of medical consumption, and excessive and inadequate use in medical services, and so on-still increase. After a hospital provides services, its fees are mainly compensated by medical insurance institutions (hereinafter referred to as health care). Scientifically charging the payment for medical treatment can stimulate hospitals to provide high quality and appropriate medical services. The control of medical cost is a worldwide problem. Because the reasons for growth of medical expense are complex, the control is a long-term and difficult task. We must tackle the problem of a 3D (medical, health care, medicine) linkage. The reform of health care payment is a major means to control the cost, which has been adopted in the practice of most countries in the world. Medical expense payments are specific methods used by social medical insurance instituti
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