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Tripartite Evolutionary Game and Simulation Analysis of Healthcare Fraud Supervision under the Government Reward and Punishment Mechanism.

作者信息

Zhu Change, Zhou Lulin, Zhang Xinjie, Walsh Christine A

机构信息

Department of Management, Jiangsu University, 301 Xuefu Road, Jingkou District, Zhenjiang 212001, China.

Faculty of Social Work, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada.

出版信息

Healthcare (Basel). 2023 Jul 7;11(13):1972. doi: 10.3390/healthcare11131972.


DOI:10.3390/healthcare11131972
PMID:37444806
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10341466/
Abstract

This study aims to provide useful insights for the Chinese government in dealing with healthcare fraud by creating an evolutionary game model that involves hospitals, third-party entities, and the government based on the government reward and punishment mechanism. This paper analyzes the evolutionary stability of each participant's strategy choice, discusses the influence of each element on the tripartite strategy choice, and further analyzes the stability of the equilibrium point in the tripartite game system. The results show that (1) the government increasing fines on hospitals is conducive to compliant hospital operations, and the incentive mechanism has little effect on such operations; (2) the lack of an incentive mechanism for third parties results in false investigations by third parties; and (3) rewards from higher levels of government promote strict supervision by local governments, but that the high cost of supervision and rewards for hospitals inhibits the probability of strict supervision. Finally, Matlab 2020a is used for simulation analysis to provide a reference for the government to improve the supervision of healthcare fraud.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/6190e85ee1f3/healthcare-11-01972-g015.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/8c7ab850a556/healthcare-11-01972-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/a1a4d14c806d/healthcare-11-01972-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/42b65c7ca864/healthcare-11-01972-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/a9aacdf34d99/healthcare-11-01972-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/15afa588bc1a/healthcare-11-01972-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/eb6ed7ee40ce/healthcare-11-01972-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/24e05fb851d2/healthcare-11-01972-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/a48a3102d984/healthcare-11-01972-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/34eee3ce772c/healthcare-11-01972-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/25160a501617/healthcare-11-01972-g010.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/a45759610c9f/healthcare-11-01972-g011.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/3f88c4a7c2b0/healthcare-11-01972-g012.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/50d58233ff4b/healthcare-11-01972-g013.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/e25a9dd8182a/healthcare-11-01972-g014.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/6190e85ee1f3/healthcare-11-01972-g015.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/8c7ab850a556/healthcare-11-01972-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/a1a4d14c806d/healthcare-11-01972-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/42b65c7ca864/healthcare-11-01972-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/a9aacdf34d99/healthcare-11-01972-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/15afa588bc1a/healthcare-11-01972-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/eb6ed7ee40ce/healthcare-11-01972-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/24e05fb851d2/healthcare-11-01972-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/a48a3102d984/healthcare-11-01972-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/34eee3ce772c/healthcare-11-01972-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/25160a501617/healthcare-11-01972-g010.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/a45759610c9f/healthcare-11-01972-g011.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/3f88c4a7c2b0/healthcare-11-01972-g012.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/50d58233ff4b/healthcare-11-01972-g013.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/e25a9dd8182a/healthcare-11-01972-g014.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d387/10341466/6190e85ee1f3/healthcare-11-01972-g015.jpg

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本文引用的文献

[1]
Incidence of moral hazards among health care providers in the implementation of social health insurance toward universal health coverage: evidence from rural province hospitals in Indonesia.

Front Public Health. 2023

[2]
No evidence of the effect of the interventions to combat health care fraud and abuse: a systematic review of literature.

PLoS One. 2012-8-24

[3]
Dying of corruption.

Health Econ Policy Law. 2011-10

[4]
A survey on statistical methods for health care fraud detection.

Health Care Manag Sci. 2008-9

[5]
Markets, information asymmetry and health care: towards new social contracts.

Soc Sci Med. 2008-5

[6]
Healthcare fraud: whose problem is it anyway?

J Am Med Inform Assoc. 2008

[7]
Beyond the anti-kickback statute: new entities, new theories in healthcare fraud prosecutions.

J Health Law. 2007

[8]
Supervision in social health insurance: a four country study.

Health Policy. 2005-3

[9]
Application of quantitative models from population biology and evolutionary game theory to tumor therapeutic strategies.

Mol Cancer Ther. 2003-9

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