医保支付方式与公立医院系统绩效的关系研究

With the carry out of the national medical insurance, how the payment mode of medical insurance guide the hospital and patient to realize win-win has become the key issues of the reforming of public hospital and even the whole national medical. As the absent of the system theory research, we are now unclear how each mode of payment influence the performance of public hospital system(including medical insurance, hospital, patient , government), how each mode can be carried out, what policy is needed. The program establishes a public hospital model with system dynamics, game theory, econometric methods, to carry out the simulator investigation of the policy by putting into different payment modes, different payment levels, different payment policies. The program evaluates multi objectively and compare the results of the performance with TOPSIS, to analyse the optimal matching between different payment modes, different payment levels, different payment policies and the performance of public hospital system. The program puts forward different policies to different status of the optimal matching by the ways of system feedback, policy simulation experiments, game theory. The program has three innovations: to carry out the theory research and the empirical analysis with a system engineering method, to establish models with different ways to study the health system science , to evaluate multi objectively the performance of public hospital from the view of payment mode of medical insurance. The achievement of the program can offer support and be a reference to the improvement of the payment mode of medical insurance and the reforming of public hospital.

实施全民医保后，如何发挥医保支付方式对医院和患者的引导作用，实现共赢，已成公立医院改革和整个医改核心问题；但由于缺乏系统理论研究，仍不清楚每种支付方式对公立医院系统绩效（含医保、医院、患者、政府四维）的影响程度和方式、需要的配套政策及实施条件。本项目运用系统动力学、博弈论及计量经济方法构建公立医院系统模型，反复调整支付方式、支付水平、配套政策等输入，进行政策模拟研究；运用TOPSIS方法对输出结果（绩效值）进行多目标评价和比较，分析支付方式、支付水平、配套政策与公立医院系统绩效的最优匹配；运用系统反馈、政策实验仿真和博弈论方法针对不同最优匹配状态提出相应管理对策。本项目研究有三个创新：用系统工程方法对该问题进行理论研究与实证分析；综合多种方法构建数量模型开展卫生体系科学的深入探讨；从医保支付角度对公立医院绩效进行多目标评价。成果可为医保支付方式的完善及公立医院改革提供支持和参考。

实施全民医保后，如何发挥医保支付方式对医院和患者的引导作用，实现共赢，已成公立医院改革和整个医改核心问题；但由于缺乏系统理论研究，仍不清楚每种支付方式对公立医院系统绩效（含医保、医院、患者、政府四维）的影响程度和方式、需要的配套政策及实施条件。.本项目运用系统动力学、博弈论及计量经济方法构建公立医院系统模型，反复调整支付方式、支付水平、配套政策等输入，进行政策模拟研究；运用TOPSIS方法对输出结果（绩效值）进行多目标评价和比较，分析支付方式、支付水平、配套政策与公立医院系统绩效的最优匹配；运用系统反馈、政策实验仿真和博弈论方法针对不同最优匹配状态提出相应管理对策。.我们评估了2011年至2019年省级公立医院的效率，采用基于可加性指标和总的方向距离函数的方法（DDF）。所采用的方法允许将全要素生产率（TFP）指标分为三个部分，包括技术效率变化（TEC）、总生产率（TP）和规模效率变化（SEC）。在效率评估之后，我们进行后效率分析，找出公立医院效率的决定因素。结果表明，全要素生产率年均增长率为1.38%，主要受技术效率的驱动。公立医院绩效的地区差异正在扩大。考查的样本中，近75%的公立医院显示全要素生产率正增长。回归结果表明，公立医院效率的决定因素包括医院的价格和对医疗服务的需求。.本项目研究有三个创新：用系统工程方法对该问题进行理论研究与实证分析；综合多种方法构建数量模型开展卫生体系科学的深入探讨；从医保支付角度对公立医院绩效进行多目标评价。成果可为医保支付方式的完善及公立医院改革提供支持和参考。