The Theoretical and Experimental Study on Reform of Payment System for Reimbursement to Medical Institutions

医疗机构报销制度改革的理论与实验研究

• 批准号: 13630078
• 负责人: INAGAKI Hideo
• 金额: $ 2.18万
• 依托单位: Yokkaichi University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 2001
• 资助国家: 日本
• 起止时间: 2001 至 2002
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-13630078/
• 关键词: DRG-PPS; patient's selective behavior; national medical costs; swingback of reimbursement cost; Fee-for-Service; patient benefit; hospital profit; composite payment system; 包括支払; モノ; サービス; 実験経済学; 過剰診療; 過少診療; 代理人; 報酬単価; 患者選別; 実験経済学的手法; 混合

DRG-PPS (Dynagoses Related Group and Prospective Payment System) for medical rewards has been introduced to the United States of America and other countries reducing national medical costs, especially hospital payments.The Japanese authority also plans to adapt DRG-PPS to the existing medical reward system. However, the Japanese market for health care is characterized by the most severe competition among hospitals since patients can freely choice and change any hospital that they visit.Therefore, to analyze effects concerning an introduction of DRG-PPS into the Japanese health market needs a dynamic framework possible to that patient choices hospital repeatedly.In this project, we investigate1) whether the introduction of DRG-PPS decreases a per capita service level of health care or not,2) whether any swingback of reimbursement cost for health care happened in the periods that follow it or not,and 3) what kind of medical payment system fulfills any optimal supply for health care.Summarizing the results, first, the per capita service level of health care supplied in steady state is the identical to every hospital, regardless of that each hospital has a different agent coefficient. Then the introduction of DRG-PPS happen to decrease the service level of health care relatively to under Fee-for-Service.Next, when we investigate dynamic paths to converge on equilibrium, we can find the swingback of reimbursement cost for health care. The swingback of reimbursement cost means that reimbursement cost in steady state becomes much larger than in the morrow of introducing DRG-PPS. This phenomenon arises when some hospitals extremely respect patient benefit rather than hospital profit.Finally, under certain condition, there is a composite payment system to maximize the net benefit for patient that deducts a medical cost from a patient benefit gained by receiving health care.

用于医疗奖励的DRG-PPS（Dynagoses Related Group and Prospective Payment System）已被引入美国等国家，降低国家医疗成本，特别是医院费用。日本当局还计划将DRG-PPS适应现有的医疗奖励制度。然而，日本的医疗市场是医院间竞争最激烈的市场，患者可以自由选择和更换就诊的医院。因此，为了分析将DRG-PPS引入日本医疗市场的效果，需要一个动态的框架，使患者能够反复选择医院。在本项目中，我们调查1）DRG-PPS的引入是否降低了人均医疗服务水平，2）在随后的时期内是否发生了医疗报销费用的任何回摆，（3）什么样的医疗支付制度能够满足最优的医疗服务供给，总结分析结果，第一，在稳态下，每家医院的人均医疗服务供给水平是相同的，而不管每家医院的代理系数是不同的。然后，当我们考察动态路径收敛于均衡点时，我们可以发现医疗补偿成本的回摆。补偿成本的回摆意味着稳态下的补偿成本比引入DRG-PPS后的补偿成本要大得多。最后，在一定条件下，存在一种复合支付制度，即从患者获得的医疗服务收益中扣除医疗费用，以使患者的净收益最大化。

项目成果

Akagi, H., H.Inagaki, S.Kamata, T.Mori: "A Dynamics for Patient's Selective Behavier and Medical Expenses under A Composite Payment System"Discussion Paper Series (Faculty of Urban Science, Meijo University). USM-01-01. 1-29 (2001)

Akagi, H.、H.Inagaki、S.Kamata、T.Mori：“综合支付系统下患者选择性行为和医疗费用的动态”讨论论文系列（名城大学城市科学学院）。

Hirobumi AKAGI, Hideo INAGAKI, Shigenori KAMATA, Toru MORI: "A Dynamics for Patient's Selective Behavior and Medical Expenses under A Composite Payment System"Discussion Paper Series (Faculty of Urban Science ; Meijo University). UMS-01-01. 1-28 (2001)

Hirobumi AKAGI、Hideo INAGAKI、Shigenori KAMATA、Toru MORI：“综合支付系统下患者选择行为和医疗费用的动态”讨论论文系列（名城大学城市科学学院）。

Akagi, H., H. Inagaki, S. Kamata and T. Mori: "A Dynamics for Patient's Selective Behavior and Medical Expenses under A Composite Payment System"Discussion Paper Series (Faculty of Urban Science; Meijo University). USM-01-01. 1-29 (2001)

Akagi, H.、H. Inagaki、S. Kamata 和 T. Mori：“综合支付系统下患者选择行为和医疗费用的动态”讨论论文系列（名城大学城市科学学院）。