Research On The Design Of Medical Insurance Reimbursement Mechanism Considering Internet Healthcare Platform

China’s medical and health care system faces the dilemma of imbalance between supply and demand of medical resources and uneven structural distribution.Optimizing the allocation of medical resources and guiding patients to seek medical treatment in an orderly manner is an inevitable step of medical system reform.Internet hospitals are strongly advocated by the government as they can effectively alleviate the problem of uneven structure of medical resources and break through the time and space limitations of traditional hospitals.Currently,in order to promote the development of Internet healthcare,the government has included Internet healthcare into medical insurance payments and implemented the same reimbursement ratios and pricing standards as traditional hospitals on a trial basis,but due to the inherent asymmetry of medical information,patients have concerns about the service quality of Internet healthcare platforms,resulting in the implementation effect falling short of expectations.However,current research on Internet healthcare has focused on operational models and security,and there is an urgent need to study effective reimbursement mechanisms.In view of this,this dissertation constructs a medical service system that includes an Internet healthcare platform and a traditional hospital,and studies the impact of differential health insurance reimbursement mechanism on the effective deployment of online and offline medical resources and medical insurance fund operation efficiency,in order to provide theoretical support for promoting the long-term development of Internet hospitals and improving the health care system.The specific research work of this dissertation is as follows.First,this paper constructs a fixed-budget-based model of health insurance reimbursement mechanism for healthcare system,adopts the inverse induction method to solve the equilibrium of the government reimbursement hospital selection and the corresponding reimbursement ratio,and also investigates the impact of factors such as the maximum perceived health value of patients,the difference in perceived health value between two hospitals,and cost on the social welfare level by means of numerical simulation,and the following conclusions are finally drawn: only moderate reimbursement ratio can ensure the existence of a duopoly market,otherwise,one of the hospitals will exit the market.The higher the level of government budget,the greater the difference in patients’ perceived health value between the two hospitals,and the higher the maximum perceived health value,the better it is for the government to achieve the goal of optimizing social welfare,when the equilibrium decision of the government is to reimburse both hospitals,and increasing the reimbursement ratio gap between traditional hospital and Internet healthcare platform is conducive to achieving the goal;only when the cost of traditional hospital is low and the difference in patients’ perceived health value between the two hospitals is great,the equilibrium decision of the government is to reimburse only the traditional hospital.Then,this dissertation constructs a minimum-budget-based healthcare insurance reimbursement mechanism model for the healthcare system,uses the inverse induction method and Kuhn-Tucker method to solve the equilibrium for the minimum government health insurance fund budget,and concludes the following: the minimum budget is positively related to the cost of two hospitals and the perceived health value difference and negatively related to the maximum perceived health value of patients;when the government budget is the minimum budget,the equilibrium decision of the government is to reimburse only the traditional hospital when the cost difference between the traditional hospital and the Internet hospital is relatively small and the difference between the patients’ perceived health value is large;when the government budget is higher than the minimum budget,if the difference between the perceived health value of the two hospitals is small and the maximum perceived health value of the patients is small,then the government should reimburse both hospitals,otherwise only the traditional hospital should be reimbursed.This dissertation analyzes the government’s optimal reimbursement decision from a social welfare perspective,and proposes theoretical guidance and policy recommendations for the improvement of health insurance reimbursement policies for healthcare systems.