基于“价值”导向的支付方式对医联体激励约束机制和政策优化研究

本研究综合运用行为经济学、实验经济学和系统动力学，将实证研究、实验研究和系统仿真相结合，定性与定量相结合，以价值为目标导向，把医联体外部支付方式和内部利益分配机制有机结合，明确支付方式对医联体激励约束机制要素框架，在实证研究基础上通过期望理论建立“期望收益差—决策努力程度—实际决策行为”之间的定量关系。通过实验经济学分析内外部支付方式不同组合下，医联体核心和非核心医疗机构管理者的决策行为努力程度和决策结果，并通过建立“支付方式—期望收益差—决策努力程度—实际决策行为—价值目标”之间的仿真模型，运用系统动力学的敏感性分析确定激励约束关键环节，通过优化经济激励约束机制促进建立医联体利益共同体，实现服务共同体和管理共同体，为完善支付方式，建设基于价值的医疗服务体系提供理论和实践依据。本研究为评估支付方式对医联体激励约束效果提供了价值导向新视角，拓展了行为经济学、实验经济学和系统动力学运用领域。

This study used the behavioral economics, experimental economics and system dynamics, integrated the empirical research, experiment research and system simulation, combined the qualitative, quantitative methods and the view of value-based healthcare, combined the external payment methods and internal interest distribution way of medical alliance, specified the economic incentive and restrictive mechanism elements of medical alliance with different payment methods, established the quantitative relationship between the "expect spreads - decision making effort - actual decision making behavior", which based on empirical research and the expectation theory. In this study, we analyzed the core and non-core medical institutions managers' decision making behavior effort and results under different combination of internal and external payments by experimental economics, and established the simulation model between "payment methods - expect spreads - decision making efforts - actual decision making behavior - value targets", determined the key link of economic incentive and restrictive mechanism through the system dynamics sensitivity analysis, established the medical alliance of shared interests by optimizing the economic incentive and restrictive mechanism, promoted the medical alliance of shared service and management, to provide the theory and practice basis of improving payment methods and constructing health service system based on the value, through the optimization of economic incentive constraint mechanism of medical alliance to promote to establish the medical benefit community, service community and management community, provided the theory and practice basis to improve the payment method and construct health service system based on the value. This study provides a new perspective of value-based healthcare for the effect of payment method on the economic incentive and restrictive mechanism of medical alliance, and expands the field of behavioral economics, experimental economics and system dynamics.