Gong Hanxiang, Wang Xi, Zhang Tao, Li Jinghua, Chen Baoxin
Faculty of Humanities and Social Sciences, Macao Polytechnic University, Macao, People's Republic of China.
The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China.
Risk Manag Healthc Policy. 2023 Aug 7;16:1435-1454. doi: 10.2147/RMHP.S422296. eCollection 2023.
The new round of medical reform is a significant exploration of reform in the public service sector in China. Health insurance regulatory departments, medical institutions, and patients, as critical stakeholders in China's medical reform, play a crucial role in the success of the reform through their strategic interactions.
Starting from the perspective of bounded rationality, applies evolutionary game theory to establish an evolutionary game model for the collaborative governance of health insurance regulatory departments, medical institutions, and patients and analyzes the stability of each party's strategy and the sensitivity of parameters in the tripartite game system.
The study shows that an equilibrium point will be formed when medical institutions provide reasonable treatment, patients choose to accept treatment, and health insurance regulatory departments adopt a lenient regulatory strategy, maximizing the interests of all parties involved in the game. Factors such as the benefits of unreasonable treatment by medical institutions, fines, and regulatory costs impact the decision-making of health insurance regulatory departments. To maximize social welfare, health insurance regulatory departments should reform payment methods, adjust medical service behaviors of medical institutions, and guide the rational allocation of medical resources; the government should increase subsidies for the operation of medical institutions and the intensity of penalties; regulatory departments should reduce regulatory costs and introduce third-party forces to strengthen health insurance supervision further.
The research findings of this paper will provide valuable insights into some countries' medical and health reform.
新一轮医改是中国公共服务领域改革的一次重大探索。医疗保险监管部门、医疗机构和患者作为中国医改中的关键利益相关者，通过其战略互动在改革成功中发挥着至关重要的作用。
从有限理性的角度出发，应用演化博弈理论建立医疗保险监管部门、医疗机构和患者协同治理的演化博弈模型，并分析三方博弈系统中各方策略的稳定性及参数的敏感性。
研究表明，当医疗机构提供合理治疗、患者选择接受治疗、医疗保险监管部门采取宽松监管策略时，将形成一个均衡点，使博弈各方的利益最大化。医疗机构不合理治疗的收益、罚款、监管成本等因素影响医疗保险监管部门的决策。为使社会福利最大化，医疗保险监管部门应改革支付方式，调整医疗机构的医疗服务行为，引导医疗资源合理配置；政府应增加对医疗机构运营的补贴和处罚力度；监管部门应降低监管成本，引入第三方力量进一步加强医保监管。
本文的研究结果将为一些国家的医疗卫生改革提供有价值的见解。
