| With the development of the medical reform,medical and health service had great advances in our country.However,there exist some problems such as the decrease of equity in medical service,the lower efficiency of health input,and so on,which lead to the quicker Increase of medical expenditures and the issue of "being unaffordable and difficult to see a doctor".The Development Research Center of the State Council made a negative evaluation that the medical reform is unsuccessful conclusively.So to further study on the issue of the medical system problems is of great both theoretical and practical significance to the Reconstruction of Medical System.This thesis,using incomplete information theory,principal-agent theory and institutional economy theory,sets up a doctor-patient game model based on making an overall explanation on the Characters of Medical Service and its market,first studies the endogenous character of Supply Induced Demand(SID)in asset specificity;secondly analyzes the different effect on medical service suppliers'behavior decision which caused by the different payment manners of medical expenses and the different medical service provision mechanism,and then to find the effective method to deal with SID;finally,provide the suggestion to reconstruct the medical system.This thesis show that the reasons of the Excessively Rapid Increasing of Medical Expenditures contain both sides of supply and demand with literature summary,and point out that SID,damaging the benefit of consumers,is a decisive factor which should be studied and concerned.Meanwhile,this thesis indicates that asymmetric information in the medical market and the dual role of provider and agent are the preconditions of SID,and the medical service suppliers would be seeking for the protect spontaneously while specific asset is lack of guarantee mechanism.Then by using contract theory,evolutionary economic theory and game theory to study its significance and feasibility,Janitor System,considered as an incentive and constraint mechanism,not only impels General Practitioners(GP)to decrease their SID by self-constraint,and also reduces special doctors' SID through GP with medical knowledge supervise special doctors' conduct.Different payment manners of medical expenses have different influential action on the medical service suppliers' behavior decision.Usually prospective payment system is more efficient on controlling SID than retrospective payment system,but there exist the problems that the suppliers maybe decrease the service quality or select patients adversely.So we should adopt appropriate payment mode according to the type of medical service and the practical situation,the mixed payment had is generally more effective on controlling SID.At the same time,this thesis analyzed the necessity and importance of the market supply and the government supply,and point out the market operation would enhance the behavior motive to carry out SID by anatomizing the "supporting medicine with drugs" policy.Finally,this thesis researches the difference of the hospital manager's behavior decision between private ownership and public ownership of the property right,and concludes that it is unwise to adopt complete marketization or complete government guiding.Only the supply of government combined with the supply of market can deal with SID and reduce medical cost.To deepen reform of China's medical system,this thesis,based on considering problems and disadvantages,puts forward managed marketization as its goal,and presents the possible path choices such as improve the system of community medical services and establish Janitor System,break with the "supporting medicine with drugs" policy and carry out medical treatment and medicine separately,reform the payment system of medical expenditure and integrated using the mode of payment,reform the property right and relocate of State-owned hospital and introduce various forms of the medical service provider,doing government supervision and regulation with choices. |
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