| 引用本文: |
牛浩然,张美成,姜峰,等.DRG背景下医生高编码行为的演化博弈分析*[J].中国卫生经济,2023,42(2):37-40,52.[点击复制] |
NIU Hao-ran,ZHANG Mei-cheng,JIANG Feng,et al.Evolutionary Game Analysis of Doctor's Up-Coding Behavior under DRG Background[J].CHINESE HEALTH ECONOMICS,2023,42(2):37-40,52.[点击复制] |
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| 摘要: |
| 目的：为了预防低码高编码行为的出现，探索医生编码过程及医保部门监管力度对患者效用的影响。方法：建立医生及医保部门行为策略选择演化博弈模型，利用Matlab仿真分析，获得多种情形的博弈双方策略稳定点。结果：高编码后医生相对正常诊断的收益、上级部门奖惩力度、监管成本均会影响博弈双方策略的选择。结论：可通过降低相对收益、增强奖惩力度、引入科学的监督系统等措施促进博弈主体向“正常诊断，严格监管”方向演变。 |
| 关键词: DRG 低码高编 演化博弈 |
| DOI： |
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| 基金项目:教育部人文社会科学研究一般项目(21YJA630062) |
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| Evolutionary Game Analysis of Doctor's Up-Coding Behavior under DRG Background |
| NIU Hao-ran,ZHANG Mei-cheng,JIANG Feng,CAO Jian-bo,LIU Ya-qing |
| (School of Medicine and Health Management,Huazhong University of Science and Technology,Wuhan 430030 ,China) |
| Abstract: |
| Objective: To prevent the occurrence of up-coding behavior，it explored the doctors' coding process and the effects of medical insurance departments' supervision on patients. Methods: The evolutionary game model of doctors' and health insurance department's behavioral strategy choice was established and analyzed by Matlab simulation to obtain the strategy stability points of both sides of the game for various situations. Results: The benefits of doctors，rewards and punishments of superior departments，and the cost of supervision will affect the strategy. Conclusion: The evolution of gaming subjects to the direction of "normal diagnosis and strict supervision" could be promoted by reducing relative returns，enhancing incentives and penalties，and introducing scientific supervision systems. |
| Key words: DRG up-coding behavior Evolutionary game |
