The Experimental Sgudy on Payment System for Reimbursement to Medical Institutions

英美两国医疗机构报销支付制度改革的方向是：美国实行按服务收费制度(FFS)，英国实行按服务付费制度(PPS)。两国寻找一套的努力充分结合了这两种类型。在医疗机构追求利润最大化的情况下，对支付制度运行的理论验证表明，PPS可能导致医疗服务供给不足，FFS可能导致医疗服务供给过剩；实证研究采用计量经济学方法验证了报销制度改革的效果。但由于医学数据收集的困难，并不能给出准确的结论。利用不需要现有数据的实验经济学方法对理论结果进行了验证。在假设医疗机构利润最大化的实验中，没有出现供过于求。对我们的实验d…进行统计测试更多的数据表明，大多数医疗机构主体关心的是患者主体的利益，而不是他们的私利。从实验结果来看，可以预期PPS的引入不会导致医疗机构的大幅下降，由于上述实验所用的理论模型不可能由患者选择医疗机构，所以我们将其扩展为一个动态模型，患者可以自由选择医疗机构。主要结果如下。从FFS转换为PPS后，医疗费用立即大幅下降。但随着选择的进展，它与FFS下的医疗费用几乎是一致的。这一结果通过基于实验经济学方法的计算机网络系统进行了检验。该实验验证了理论结果的正确性。也就是说，当患者就诊的医疗机构的治疗和平均治疗已经知道时，结果是通过患者基于两者之间的差异自由选择来相等PPS下的治疗。现在，我们正在就这一结果发表一篇文章。较少

The reform of payment system for reimbursement to medical institutions in U.K. and U.S. carries on in the direction where U.S. with fee-for-service payment system (FFS) introduced prospective payment system (PPS) and U.K. with PPS introduced FFS. The two countries efforts to search for a set combined adequately two kinds of these. If medical institution is motivated to maximize their profits, the theoretical verification about workings of the payment system has the result that PPS may causes the under-supply of treatments and FFS causes the over-supply.Empirical studies about effect which the reimbursement was changed is verified by econometric method. But precise conclusions are not given by difficulty of medical data collection. We verify the theoretical result by the method of experimental economics that does not need existing data. In the experiment assuming the profit maximization in the medical institution, the over-supply was not caused. Statistical testing to our experimental d … More ata suggests that most of medical institution subject concerned more for patient subject's benefits than for their self-profits. Judging from the result of our experiments, we can expect that the introduction of PPS does not cause drastic fall in treatments.Because the medical institution selection by patients was impossible in the theory model used by the above-mentioned experiment, we expanded it to a dynamic model, which patients can be free to select a medical institution. The main result is the following. Medical expenditures fell greatly just after switching from FFS to PPS. But it converges in almost the same as medical expenditures under FFS with progress of the selection.This result is examined by the computer network system based on the method of experimental economics. This experiment demonstrates the validity of theoretical result. That is, when the treatment of the medical institution visited by patients and the average treatment were already known, the result to equalize the treatment under PPS by the patient's free selection based on the discrepancy between the two. Now, we are making an articles about this result. Less