Pricing Of Medical Services Considering Public Welfare And Patient Selection Behavior

Medical service price is the core element of medical service,which relates to everyone’s vital interests.At present our country is gradually set up medical service pricing system,but the establishment of the medical service pricing system is a long-term and complicated task,and there are many problems in the process of the establishment of medical service pricing system in public hospitals in China.First,the pricing system of medical service based on stakeholders and public welfare is not perfect;second,the pricing method of medical service based on different regions and different levels is single,which leads to the high price of medical service and the unreasonable allocation of medical resources.The utility of stakeholders is a key issue in the pricing process.Public hospitals and patients are the final stakeholders in the pricing of medical services,and their utility has an important impact on the pricing.However,the current pricing process of medical services fails to fully consider the ultimate interests of both.In particular,in China,public hospitals are governmentsponsored medical institutions with public welfare and not for profit.Public welfare income is also an important part of public hospital income.Patient’s utility is affected by patient’s selection behavior,so patient’s selection behavior is also an important factor affecting medical service pricing.At the same time,considering that there are different power relations among medical institutions in different regions and at different levels in China,the different power structures will also affect the pricing process of medical services.In this paper,public welfare and patient selection behavior are brought into the medical service pricing process,and three medical service pricing models are constructed according to the different power structures,namely,decentralized decision-making pricing of medical service without power structure,decentralized decision-making pricing of medical service under different power structures,and cooperative decision-making pricing of medical service.This article first from the consideration of medical institutions of the perspective of public welfare and patient selection behavior,to large hospital,primary hospitals and patients as the research object,and set up the medical service without power structure decentralized decision making pricing model,based on the number of the utility function to solve medical treatment in patients and based on utility function to solve the optimal pricing of medical institutions,economic utility,and total surplus.Among them,the utility function of medical institutions includes economic utility and public welfare utility,and the utility function of patients is affected by medical service value,price,waiting time cost and differentiated medical insurance.The effects of public welfare on optimal pricing,economic utility and total patient surplus of medical services were analyzed,and verified by numerical simulation.This model lays a foundation for the subsequent research of this paper.Secondly,on the basis of the first model,based on different power structures,two decentralized decision-making pricing models of medical services led by large hospitals and primary hospitals are constructed.Among them,the decision-making process of leaders of large hospitals is as follows: large hospitals first make pricing decisions,and then primary hospitals make corresponding decisions according to the pricing decisions of large hospitals;The decision-making process of the leaders of primary hospitals is that the primary hospitals first make the pricing decision,and then the large hospitals make the corresponding decision according to the pricing decision of the large hospitals.The optimal pricing,economic utility and total patient surplus of each medical institution in the two models were solved by the reverse solution method of the complete information dynamic game,and the influence of public welfare factors on the optimal pricing,economic utility and total patient surplus of each medical institution in the two models was analyzed.Finally,MATLAB is used for numerical simulation to further verify the accuracy of the results and conclusions.Finally,the medical service pricing model under the cooperative decision of large hospitals and primary hospitals is constructed.In this model,large hospitals and primary hospitals are considered as a whole,and the optimal pricing,economic utility and total patient surplus of each medical institution under cooperative decision are solved through static game with complete information,and the effects of public welfare on optimal pricing,economic utility and total patient surplus of each medical institution are analyzed.Finally,MATLAB is used for numerical simulation.The results show that:（1）Under decentralized decision-making,especially under the leadership of large hospitals,increasing the public welfare of medical institutions not only helps to reduce the price of medical services,but also helps to narrow the price gap between large hospitals and primary hospitals;Increasing the public interest of medical institutions on difficult and miscellaneous diseases is conducive to guiding patients to choose large hospitals for treatment,increasing the total surplus of patients in large hospitals,giving full play to the advantages of large hospitals in the treatment of difficult and miscellaneous diseases,and optimizing the allocation of medical resources.（2）Without power structure and under the leadership of large hospitals,high public welfare will make the medical service price of large hospitals lower than the cost,affecting their own economic utility and normal operation of the organization.Therefore,the public welfare should be adjusted within a reasonable range to ensure the normal operation of medical institutions;For some specific diseases,when the public welfare of medical institutions needs to be greatly increased,the government should provide corresponding financial support.Under cooperative decisionmaking,the range of public welfare changes is larger than that of decentralized decisionmaking,that is,higher public welfare will not cause medical institutions to go beyond their income.Reimbursement ratio（3）Increase the basic-level hospitals can aggravate the single economic burden to the patient,and not for patients has a great influence on total surplus,so if the government does not control,will make the reimbursement ratio increase grass-roots hospital medical service prices,can’t reach the effect,to reduce the financial burden of patients to a large extent also won’t affect the patient’s medical treatment options.At the same time,the reimbursement ratio can be increased by subsidizing or regulating medical institutions to limit the price rise,or by compensating medical institutions to reduce the actual payment of patients.（4）Under the leadership and cooperative decision-making of primary hospitals,increasing the cure rate of primary hospitals will increase the economic burden of individual patients,but will increase the total surplus of patients in primary hospitals.In addition,under the leadership of large hospitals and without power structure,as the cure rate of primary hospitals increases,large hospitals withdraw from the treatment market for mild patients due to the decrease in the number of patients,which is conducive to optimizing the allocation of medical resources,implementing the policy of primary diagnosis and giving full play to the advantages of large hospitals in difficult and complicated diseases.（5）Compared with large hospitals as leaders,the price of medical services in grassroots hospitals is higher,and the price gap between large hospitals and grassroots hospitals is smaller.Leading the leaders of grassroots hospitals to make decentralized pricing decisions in the region is conducive to reducing the price gap between large hospitals and grassroots hospitals,and appropriately increasing the economic benefits of grassroots hospitals.Compared with decentralized decision,the medical service price of medical institutions under cooperative decision is higher.Based on the operating environment of medical service in China,this paper explores the pricing of medical service under different decision-making and power structures,which not only enriches the research framework and pricing model of medical service,but also provides theoretical reference for the pricing decision-making of medical service in China.