药占比管制下过度医疗行为演化研究
Evolutionary game theory on over-treatment behavior under drug-proportion regulation
查看参考文献32篇
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文摘
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过度医疗是我国医疗改革关注的重要问题之一,为有效遏制,国家继价格管制、取消药品加成等措施后,新出台药占比管制政策.基于此,本文构建药占比管制下医患行为的演化博弈模型,根据复制动态方程得到医生与患者的行为演化规律与稳定策略,分析合理医疗成本、过度医疗较合理医疗增加的成本比率、医疗总费用绩效系数与患病严重程度等因素对医生诊疗策略的影响.研究结果显示:药占比管制并不总是抑制过度医疗,其存在一重要跃迁点,药占比参考值低于该跃迁点时,反而会引发过度医疗.特别发现,在药占比管制下过度医疗与患病严重程度密切相关,医生对轻症患者更倾向于过度医疗.依据研究结论,本文对药占比指标设置,轻疾监控,分级诊疗制度及信息披露机制等方面提供可行建议. |
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其他语种文摘
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Drug-proportion regulation is on implementing following the price regulation and the elimination of markups on pharmaceuticals to curb the over-treatment,which is an important issue for Chinese healthcare reform.Based on that,we propose an evolutionary game model of doctor-patient behavior under drug-proportion regulation.Theoretically,it founds that there exists behavioral evolutionary law and stable strategies between physicians and patients according to replicator dynamics equation.Then treatment strategies are analyzed by considering normal treatment costs,the ratio of over-treatment to normal treatment costs,physician performance coefficient,and the severity of illness.The results show that drug-proportion regulation does not always inhibit over-treatment,which depends on a transition point.Physicians prefer to choose overtreatment while the drug-proportion is lower than the transition point.It is worth noting that the severity of illness affects over-treatment under the drug-proportion regulation.Physicians are prefer to over-treatment when patients are less ill.These conclusions are beneficial for drugproportion setting,light-illness monitoring,hierarchical diagnosis,and information disclosure mechanism.Finally,related healthcare policy suggestions are provided. |
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来源
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系统工程理论与实践
,2019,39(12):3163-3175 【核心库】
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DOI
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10.12011/1000-6788-2018-1930-13
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关键词
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演化博弈
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医疗费用
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过度医疗
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药占比
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地址
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1.
河北工业大学经济管理学院, 天津, 300401
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美国宾夕法尼亚州立大学信息科学与技术学院, PA16802
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语种
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中文 |
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文献类型
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研究性论文 |
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ISSN
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1000-6788 |
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学科
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社会科学总论;预防医学、卫生学 |
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基金
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国家社会科学基金
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文献收藏号
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CSCD:6697618
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参考文献 共
32
共2页
|
|
1.
廖新波. 单纯降低"药占比"有意义么?.
南方日报,2015
|
CSCD被引
2
次
|
|
|
|
|
2.
Dulleck U. On doctors,mechanics,and computer specialists:The economics of credence goods.
Journal of Economic Literature,2006,44(1):5-42
|
CSCD被引
6
次
|
|
|
|
|
3.
Currie J. Patient knowledge and antibiotic abuse:Evidence from an audit study in China.
Journal of Health Economics,2011,30(5):933-949
|
CSCD被引
7
次
|
|
|
|
|
4.
黄涛. 医疗信任商品的信号博弈分析.
经济研究,2009,44(8):125-134
|
CSCD被引
7
次
|
|
|
|
|
5.
朱恒鹏. 管制的内生性及其后果:以医药价格管制为例.
世界经济,2011,34(7):64-90
|
CSCD被引
7
次
|
|
|
|
|
6.
杜创. 价格管制与过度医疗.
世界经济,2013,36(1):116-140
|
CSCD被引
6
次
|
|
|
|
|
7.
卢洪友. 中国医疗服务市场中的信息不对称程度测算.
经济研究,2011(4):94-106
|
CSCD被引
12
次
|
|
|
|
|
8.
Kerschbamer R. How social preferences shape incentives in (experimental) markets for credence goods.
The Economic Journal,2017,127(600):393-416
|
CSCD被引
2
次
|
|
|
|
|
9.
Arrow K J. Uncertainty and the welfare economics of medical care.
The American Economic Review,1963,53(5):941-973
|
CSCD被引
9
次
|
|
|
|
|
10.
Jiang B. Signaling through pricing by service providers with social preferences.
Marketing Science,2014,33(5):641-654
|
CSCD被引
4
次
|
|
|
|
|
11.
Liu T. Credence goods markets with conscientious and selfish experts.
International Economic Review,2011,52(1):227-244
|
CSCD被引
3
次
|
|
|
|
|
12.
田森. 专家服务市场的欺诈、信任与效率-基于社会偏好和空谈博弈的视角.
经济研究,2017,52(3):195-208
|
CSCD被引
4
次
|
|
|
|
|
13.
Olivella P. Reputational concerns with altruistic providers.
Journal of Health Economics,2017,55:1-13
|
CSCD被引
2
次
|
|
|
|
|
14.
杜创. 动态激励与最优医保支付方式.
经济研究,2017,52(11):88-103
|
CSCD被引
3
次
|
|
|
|
|
15.
薛大东. 医疗服务供方声誉机制的形成障碍及政策建议.
卫生经济研究,2016(6):5-8
|
CSCD被引
1
次
|
|
|
|
|
16.
Alger I. A theory of fraud and overtreatment in experts markets.
Journal of Economics & Management Strategy,2006,15(4):853-881
|
CSCD被引
4
次
|
|
|
|
|
17.
Dulleck U. The economics of credence goods:An experiment on the role of liability,verifiability,reputation,and competition.
American Economic Review,2011,101(2):526-555
|
CSCD被引
3
次
|
|
|
|
|
18.
Mimra W. Price competition and reputation in credence goods markets:Experimental evidence.
Games and Economic Behavior,2016,100:337-352
|
CSCD被引
2
次
|
|
|
|
|
19.
顾昕. 中国新医改的政治经济学.
广东社会科学,2017(5):176
|
CSCD被引
1
次
|
|
|
|
|
20.
朱恒鹏. 价格管制与过度医疗.
中国经营报,2018
|
CSCD被引
1
次
|
|
|
|
|
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