Game Analysis Of Interest Subjects In The Reform Of Medical Insurance Payment Mode

Since the new round of medical reform,the Central Party and State Council have made a series of decisions and arrangements around medical insurance,and have built the world’s largest basic medical insurance network covering all people.The 14 th Five-Year Plan for Universal Health Protection clearly states that by 2025,the reform of important mechanisms such as health insurance payment and fund supervision should be basically completed,and the health insurance payment mechanism should be more effective and efficient.The reform of medical insurance payment methods is not only a further deepening of the reform of China’s medical insurance system,but also a key to achieving the strategic goal of "Healthy China".However,in practice,many designated medical institutions are forced to maintain their normal operation and control the growth of medical expenses,so they may adopt some unreasonable treatment practices to relieve the pressure during the reform process,making it difficult to ensure the quality of medical services.This has led to the neglect of the quality of medical services due to the high priority given to the effect of cost control.However,how will the reform of health insurance payment methods affect the behavioural choices of health insurance departments,designated medical institutions and insured patients? Will these effects have a negative impact on the continued deepening of the reform of health insurance payment methods? The reform of health insurance payment methods must take into account the behavioural choices of health insurance departments,designated medical institutions and insured patients.Therefore,in the context of deepening the reform of the medical insurance system,we analyse the game behaviors of the interest players in the reform of the medical insurance payment method,and build a win-win game mechanism of cooperation among doctors,insurance providers and patients.Based on the perspective of game,this paper constructs a game model of medical insurance department,designated medical institutions and insured patients,simulates the dynamic game process of game subjects,and analyses how to balance the interests and demands of game subjects in the process of medical insurance payment reform,seeks the equilibrium point of each game model,and promotes the cooperation of each game subject in the reform process.The study also examines how to balance the interests and demands of various game players in the process of health insurance payment reform,find the equilibrium point of each game model,and encourage the game players to form a synergy in the reform process to promote the continuous deepening of health insurance payment reform.The two payment methods,payment by service(FFS)and payment by disease(DIP),have been selected for game and comparison analysis:1.Compared to the FFS payment method,the DIP payment method can avoid the practice of providing excessive medical services by the designated medical institutions,but there is also an easy curtailment of medical services leading to inadequate treatment,which makes it difficult to ensure the quality of medical services.2.Compared to the FFS payment method,the DIP payment method can avoid the demand inducing behaviour of the designated medical institutions to provide treatment to the insured patients within the fixed amount of medical insurance;whereas the FFS payment method can provide incentives for the designated medical institutions to increase medical expenses indefinitely.3.The probability of fixed-point medical institutions providing unreasonable medical services under the FFS and DIP payment methods is the same,and by increasing the penalty,reducing the cost of supervision and 4.The DIP payment method can curb at source the idea that insured patients can use excessive medical treatment to commit fraud and guide them to take the initiative to save health insurance funds.Therefore,by constructing a win-win interest game mechanism of cooperation among doctors,insurance and patients,it can help deepen the reform of medical insurance payment method continuously.