Wang Chan, Nie Pu-Yan
Institute of Industrial Economics, Jinan University, Guangzhou, 510632, People's Republic of China.
Guangdong University of Finance & Economics, Guangzhou, 510320, People's Republic of China.
Int J Equity Health. 2016 Nov 15;15(1):184. doi: 10.1186/s12939-016-0468-8.
Poor medical care and high fees are two major problems in the world health care system. As a result, health care insurance system reform is a major issue in developing countries, such as China. Governments should take the effect of health care insurance system reform on the competition of hospitals into account when they practice a reform. This article aims to capture the influences of asymmetric medical insurance subsidy and the importance of medical quality to patients on hospitals competition under non-price regulation.
We establish a three-stage duopoly model with quantity and quality competition. In the model, qualitative difference and asymmetric medical insurance subsidy among hospitals are considered. The government decides subsidy (or reimbursement) ratios in the first stage. Hospitals choose the quality in the second stage and then support the quantity in the third stage. We obtain our conclusions by mathematical model analyses and all the results are achieved by backward induction.
The importance of medical quality to patients has stronger influence on the small hospital, while subsidy has greater effect on the large hospital. Meanwhile, the importance of medical quality to patients strengthens competition, but subsidy effect weakens it. Besides, subsidy ratios difference affects the relationship between subsidy and hospital competition. Furthermore, we capture the optimal reimbursement ratio based on social welfare maximization. More importantly, this paper finds that the higher management efficiency of the medical insurance investment funds is, the higher the best subsidy ratio is.
This paper states that subsidy is a two-edged sword. On one hand, subsidy stimulates medical demand. On the other hand, subsidy raises price and inhibits hospital competition. Therefore, government must set an appropriate subsidy ratio difference between large and small hospitals to maximize the total social welfare. For a developing country with limited medical resources and great difference in hospitals such as China, adjusting the reimbursement ratios between different level hospitals and increasing medical quality are two reasonable methods for the sustainable development of its health system.
医疗服务质量差和费用高是全球医疗体系中的两大主要问题。因此，医疗保险制度改革是包括中国在内的发展中国家的一个重大问题。政府在进行改革时应考虑医疗保险制度改革对医院竞争的影响。本文旨在探讨在非价格管制下，不对称医疗保险补贴以及医疗质量对患者的重要性对医院竞争的影响。
我们建立了一个具有数量和质量竞争的三阶段双寡头模型。在该模型中，考虑了医院之间的质量差异和不对称医疗保险补贴。政府在第一阶段决定补贴（或报销）比例。医院在第二阶段选择质量，然后在第三阶段确定数量。我们通过数学模型分析得出结论，所有结果均通过逆向归纳法获得。
医疗质量对患者的重要性对小医院的影响更强，而补贴对大医院的影响更大。同时，医疗质量对患者的重要性会加剧竞争，但补贴效应会削弱竞争。此外，补贴比例差异会影响补贴与医院竞争之间的关系。此外，我们基于社会福利最大化得出了最优报销比例。更重要的是，本文发现医疗保险投资基金的管理效率越高，最佳补贴比例就越高。
本文指出补贴是一把双刃剑。一方面，补贴刺激医疗需求。另一方面，补贴会提高价格并抑制医院竞争。因此，政府必须在大医院和小医院之间设定适当的补贴比例差异，以实现社会总福利最大化。对于像中国这样医疗资源有限且医院差异巨大较大的发展中国家来说，调整不同级别医院之间的报销比例并提高医疗质量是其卫生系统可持续发展的两种合理方法。
