Research On Pricing Method Of Single Disease And Government Compensation In Public Hospital

With the new medical reform entering "deep water zone",medical service pricing becomes a focus issue.The medical service market is different from the ordinary commodity market,which is mainly due to the double failure of the medical service market,which is the market failure and the government failure.Because of patients and the government's lack of knowledge of medical pharmacy,disease diagnosis and treatment of patients with basically decided by health providers.So there is moral hazard that the supplier induces demand in the process of providing medical service.Medical institutions had been always taking the way of paying by medical service projects for a long time in our country.Although the price of medical service projects is set by the government departments,the number of medical service projects in patients receiving medical services is determined by health providers.Therefore,there is a wide range of problems such as the induced demand of the supplier and the excessive medical treatment.Additional medical services has social public welfare,so many governments have social medical insurance policies.Due to the existence of third-party payment medical expense,medical service price sensitivity of patient is greatly reduced.There is the excessive medical moral risk from patients.The free price mechanism that the government does not intervene inevitably leads to the rapid rise of medical expenses.If the government interferes with the medical market,especially when the medical expenses are being controlled by upper limit,the medical institution can reduce the medical quality to guarantee the profit.Because the medical service is trust product and the quality of the medical service is less likely to be assessed by the patient and the government.There is the phenomenon of prevarication of severely ill patients,and exists adverse selection.How to set scientific and rational price of medical service has become the key to ensure the accessibility of medical service product,and to ensure the medical institutions can make up the cost.Additionally,the scientific and rational pricing of medical service can incentive medical institution ensure the quality of medical service and take the initiative to save costs,and provide appropriate medical services to patients.From the perspective of welfare economics and health economics,disease pricing and government compensation have been analyzed using grey theory and game theory.In view of that actual problem existing in the current situation of the pricing process and government compensation,a single disease pricing and government compensation method with game theory based on disease demand and disease cost analysis are proposed.A series of studies have been carried out on the issues of disease pricing and government compensation.Firstly,based on the meta-analysis,the key factors that influence the demand of diseases are discovered,and the prediction models for disease demand based on GM(1,N)with across effect and An improved Grey Markov Chain model by Taylor approximation have been presented.There is a disease demand upper bound constraint for disease pricing and government compensation decision.Secondly,in view of that characteristic of the cost of disease and the actual problems in the analysis of disease cost in China,a method for calculating disease cost based on knowledge capital of medical personnel is proposed.Disease cost estimation model based on Grey Relational Analysis and case-based reasoning improvedby the cuckoo search algorithm is proposed.There is a disease cost bound constraint for disease pricing and government compensation decision.Thirdly,based on the analysis of disease demand and cost,the interest orientation of government and medical institutions is analyzed.In this study a model of the disease pricing and government compensation based on non-cooperative game is presented.Based on social welfare maximization as the goal,the quality price sequential game model under a duopoly medical service market,and two-phase game model between the government and medical institutions under the dual regulation of price and financial compensation are established.The Nash equilibrium quality of sequential game is lower than to the social balance quality because price competition weakens the quality competition effect.If fixed cost in quality investment is controlled in certain range,the quality under the dual regulation in price and financial compensation is better than the quality under the sequential game.So it proves that the government ' s dual regulation in price and financial compensation is effective.When the government carries on the price regulation and the financial compensation to the medical institution,the government must adopt the market access control mechanism,to controls the medical institution size.The government should apply two discriminatory compensation laws to afford the financial compensation to medical institutions.The first part is to compensate the fixed cost of the quality investment of medical institutions to avoid the risk of quality decline.The second part is according to the demand density of medical market disease and the unit transportation cost of medical treatment,so as to avoid the medical institutions to excuse serious patients.Fourthly,based on behaviors analysis of the relevant parties,the bargaining game between a coalition of government and patient as a payer,and medical institutions to form the price of medical service is put forward.In the first stage,the coalition of government and patients,as leaders,make decisions on the price of diseases according to the maximum social welfare.Then the medical institutions,as followers,make decisions on the quality of medical service,and the Stackelberg equilibrium solution of the disease price and quality is found.In the second stage,medical institutions,as leaders,in the game make the optimal decision on quality based on the maximization of the profit.Then the coalition make the optimal decision on price of disease according to the maximum social welfare,and obtain the other Stackelberg equilibrium solution.The two equilibrium solutions,as the initial solution of bargaining model,according to the bargaining power of the two parties,the Rubinstein games are carried out to obtain the final Rubinstein bargaining solution.Finally,the Government and patients share the expense of medical treatment for the disease,based on the minimization of socially unnecessary losses.The results show that the equilibrium pricing is not only directly related to the cost of disease,but also related to the price elasticity of demand of disease and quality preference coefficient of patients,and government compensation is not only related to the cost of disease,but also related to the risk aversion coefficient of patients.