Research On Medicare Payment Optimization Model Considering Medical Behavior Regulation Of Medical Service Providers

Recently,the increasing of healthcare cost has became one of difficult social problem in our country.Accroding to the released statistics from Chinese insurance asset management association showed,the growth rate of public health expenditure reach 35%.If this trend can not be controlled effectively,the fiscal gap of healthcare cost will amount to 9000-1 trillion yuan in 2030 years.Due to the rapid growth of the medical insurance fee,medical insurance funds in the optimization of using medical insurance funds at all levels hospital has been paid attention among domestic scholars widespreadly.At present,many scholars had lot of empirical research of optimized configuration of health insurance.Established the evaluation index system of health care payment,making the payment process better in our country.However,with the controlling of health service prodiver becoming the focus in research,there need more description of mathematical to research and solve the problem of medical insurance fund optimization management.Based on this,it is significant to solve the problem of the optimization of the hospital medical insurance payment from the hospital perspective in this paper.The main work showed as follows:(1)Studied the medicare payment optimization problems of single department and single cycle.Considered the uncertain of medical demand and the volatile of medicale price,built the utility function as basic modle to show the department profit.Based on that,introduce the regulatory factors,built the medicare cost model and the department of utility model in two circumstances which allow medicare funds overweight and not allow medicare funds overweight.We got the optimal level of behavior regulation and optimal regulation time through solving the modle we built and combined with an example the carried on the simulation analysis.(2)Studied the medicare payment optimization problems of single department and multicycle.Considered the conception of uncertain demand and medical price in fourh chapter,introduce the characteristics of regulatory efficiency declining,built the department utility model in two circumstances which allow medicare funds overweight and not allow medicare funds overweight.Length of the regulatory cycle and medical cycle was considered in the process of solving the modle and derived the initial condition of guarantee regulatory effective.Finally,we got the optimal behavior regulation level under different situation through the simulation analysis.(3)Studied the medicare payment optimization problems of multi-department and single cycle.In the case of allow department using funds freely,built the hospital utility model in two circumstances which allow medicare funds overweight and not allow medicare funds overweight.In the case of not allow department using funds freely,minimum quota of capital verification and initial condition of regulatory were proved and built the hospital utility model.We got the optimal regulation supervisory level and time and funds warning level through solving the three modles and analysised the influence of realte parameters based on simulation.Through the deeply studied on the optimization problem of medicare payment,the influence of supervision on hospital was clear and put forward some suggestions for optimize medicare payment.