| 医联体的下转激励: 捆绑支付vs分开支付 |
| How to Incentive the Downstream Referral in a Medical Union: Bundled Payment vs Unbundled Payment |
| 摘要点击 6 全文点击 0 投稿时间：2024-06-15 修订日期：2025-06-20 |
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| 中文关键词 医疗服务运营; 垂直整合; 医联体下转; 医保支付方式 |
| 英文关键词 healthcare operations; vertical integration; downstream referral; medical payment schemes |
| 基金项目 创新研究群体科学基金,国家杰出青年科学基金 |
| 投稿方向 |
| 作者 | 单位 | 邮编 | | 甘燕红 | 华南理工大学 | 510640 | | 周文慧* | 华南理工大学 | 510640 |
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| 中文摘要 |
| 医保局鼓励成员医院通过垂直整合构建医联体来推动下转, 同时也设计医保支付方式来激励医联体积极下转. 本文先分析捆绑支付和分开支付下, 垂直一体化程度对医联体下转决策的影响; 然后对比两种支付的下转效果. 研究发现: 1) 捆绑支付下, 下转决策与一体化程度不相关; 分开支付下, 最优下转量和最优努力程度均随着一体化程度的增加而增加. 2) 与一体化程度中等的医联体相比, 一体化程度很弱或很强的医联体的社会总成本总是更小. 3) 捆绑支付的最优下转量和最优努力程度更高, 下转效果更好. 4) 面对一般形式的医联体, 两种支付方式都无法实现双赢. 捆绑支付能给医联体带来更多利润, 但也会产生更高的社会成本. |
| 英文摘要 |
| The payer encourages hospitals to vertically integrate and form a general medical union to promote the downstream referral program. Also, the payer designs payment schemes to incentive the medical union. This paper first analyzes the impact of vertical integration on the referral decisions under the bundled payment and the unbundled payment, and then compares the effect of these two payments. This paper finds that: 1) Under bundled payment, the referral decisions are not related to the degree of vertical integration; but under unbundled payment, the optimal referral volume and the optimal effort level both increase with the degree of vertical integration. 2) Compared with the medical union with medium degree of vertical integration, the total social cost of the medical union with very weak or strong vertical integration is always smaller. 3) Under bundled payment, the optimal referral volume and the optimal effort level are higher, i.e., a better downstream referral results. 4) Faced with the general medical union, no payment can achieve a win-win situation. Bundled payment can make the medical union gain a higher profit, but it also brings a higher social cost. |
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