Research On The Pricing Mechanism And Method Of Single Disease Medical Services

Along with the reform of medical price system and the development of clinicalpathway in China, the payment pattern of the traditional medical service projectstends to the payment pattern of the disease varieties. In recent years, under theguidance of the government, more and more hospitals began to reform the patterns ofsingle diseases’ fees in our country. As a price management system, modern diseasespayment pattern is a major progress of health reform in our country, and plays apositive role for the controlling medical costs reasonable and reducing the patients’burden. This dissertation researches the pricing problem of single diseases underpayment pattern of the disease varieties from the perspective of management science,and puts forward the pricing model and framework of single diseases medical servicein view of the medical service pricing research status of single diseases and thepractical problems existing in the pricing process. According to the characteristics ofthe disease costs, the dissertation researches the prediction about the medical servicecost of single diseases based on the analysis of the factors influencing the cost ofsingle diseases and interactive relationships. From the game relations amonggovernments, hospitals and patients, it studies the key technologies and methodsdeeply about the medical service pricing model of single diseases, and puts forwardthe pricing mechanism and process of single diseases. At the same time, thisdissertation also makes the positive exploration for the medical service pricingevaluation of single diseases. The main research results are as follows:First, this dissertation proposes an analysis model of factors in affecting cost ofsingle diseases. The explanation of the model is that combining the exploratoryfactor analysis and confirmatory factor analysis, establishing an index system offactors of affecting single diseases’ cost, using structural equation modeling, testingreliability and validity of the index system, estimating the parameters of the modelthrough the partial least squares (PLS), researching the strength of the interactionwith the factors of single diseases’cost, and providing the theory to predict the cost ofsingle diseases.Second, considering the different environment of cost prediction of singlediseases, the dissertation puts forward to the cost prediction of single diseasesconsidering stochastic influence factors in a uncertain environment, the cost prediction of single diseases with incomplete information, the cost prediction modelof single diseases based on the information integration in a complex-informationnoise environment, and the cost prediction of single diseases sample consideringmulti-collinear influence factors under the environment of inadequate casesrespectively. These four cost prediction method of single diseases are suitable fordifferent prediction environment using different data information from differentangles. Thus, the four cost prediction model of single diseases present acomplementary relationship, and realize accurate prediction of the medical servicecost of single diseases with appendicitis cases.Third, because of the uncertainty of the factors affecting cost prediction of singlediseases and the interaction existence of various prediction scenarios, thecorresponding deficiencies in every single forecasting method mean the one-sidednessof information sources and sensitivity in the form of the model set. In order to spreadthe risks of single forecasting model, the dissertation set up a forecast method, whichcombines fuzzy soft set theory on the basis of single disease cost forecasting, with afixed weight of single diseases’ cost. Then, because of the thought of variable weight,it puts forward to the combination forecast model based on the IOWGA operator. Theempirical analysis shows that two kinds of combination forecast method have higherprecision of prediction than each single forecast model. Therefore, the costcombination forecast method of single diseases which is told in this dissertation is notonly provide effective technical support for the feedforward control of hospital costs,but also is the basis of reasonable pricing on single diseases.Fourth, the dissertation considers the interests of the parties in the chargingsystem of single diseases under government supervision on the basis of the forecastcalculation on the cost of single diseases. It establish the double matrix game analysisof avoiding the limit of single diseases by hospital, the two stage pricing dynamicgame analysis between hospitals and hospitals and the game analysis model betweenhospitals of single diseases and patients based on the principal-agent respectively andanalyzes each game parties deeply on the basis of analyzing the feasibility of gameanalysis to the price of single disease. Then, this dissertation puts forward thecorresponding single diseases pricing process based on establishing single diseasemedical service pricing model and carries on the empirical analysis using the pricingin cesarean section as an example. Fifth, it establishes the evaluation index system of the medical service price ofsingle diseases, combines the subjective-weight method and objective-weight method,and comes up with the weighing method of price index system of single diseasesbased on the consistency of policymakers’ attitude and information entropy. Therefore,the dissertation considers the interaction between the evaluation indexes, andestablishes new pricing comprehensive evaluation index of single diseases based onCOWA-Bonferroni average operator so as to realize the comprehensive evaluation ofthe medical service price of single diseases. Through the empirical analysis, it hasrealized the price evaluation of planned cesarean delivery diseases in Hebei province.The study not only perfects the related theory of price evaluation of single diseases,but also provides the necessary basis for the further improvement on the medicalservice pricing model of single diseases.