The Theoretical and Experimental Study on Selection by Patients and Medical Physicians under The Payment System for Reimbursement to Medical Institutions

本研究的目的是考察降低医疗总费用并确保固定的待遇水平对按服务付费和预期付费并存的医疗机构报销支付制度的影响。本研究首先建立了患者可以自由选择医疗机构的理论模型，然后运用实验经济学的方法对这些理论假设进行了考察。研究结果如下：1.在医疗服务分为医生就医等“面对面服务”和检查等“千篇一律”的医疗服务的情况下，无论是利润还是患者的利益最大化，报销的差异都会对这两种医疗服务产生影响。刻板印象服务多于面对面服务，是造成医疗服务供大于求和供大于求的主要因素。2.在PPS制度下争取必要最低利润的医疗机构的治疗水平选择中，面对面服务治疗水平高于患者的疾病水平。此外，还观察了将患者介绍给其他医疗机构的行为是否有可能介绍中等程度的疾病患者。对于大病患者，引入行为较为频繁。3.如果一种疾病的单位奖励是报销总金额除以总需求分值，则医疗机构表现为Cournot-Nash竞争。随着医疗机构数量的增加和竞争的推进，该病的社会总治疗水平也随之提高。

The purpose of the research is to inspect how the reduction of the total medical expenses with securing a fixed treatment level influence on the Payment System for reimbursement to medical institutions which fee-for-service payment (FFS) and prospective payment (PPS) coexist. In this research, the theory model which patients can choose medical institutions freely is built first, and then those theory suppositions are investigated by the experimental economics method. Three points to mention in the following can be shown as the research result.1.In the case that medical service was divided into the medical service concerned with the "face-to-face service" such as treatment by the doctor and the "stereotyped service" such as inspection, the difference in the reimbursement has impact on two medical services regardless of the profit or the patient's benefit maximization. The stereotyped service was supplied more than the face-to-face service, and was the main factor in the over- and under- supply of medical service.2.In the treatment level choice of the medical institution which tries to secure the necessary minimum profit under PPS, the level of the face-to-face service treatment was higher than patient's disease level. Moreover, the patient introduction behavior to other medical institutions was observed the possibility to introduce the disease patient of the middle degree. For the serious disease patient it became clear that the introduction behavior was done frequently.3.If a unit reward of one disease was decided by dividing total amount of reimbursement by the total request score and medical institution behaved Cournot-Nash competition. The social total treatment level of this disease rose as the number of medical institutions increased and competition was promoted.