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引文資料
題名:
醫療提供者之行為策略--賽局理論之應用
書刊名:
管理學報
作者:
許碩芬
/
楊雅玲
作者(外文):
Hsu, Shuo-fen
/
Yang, Ya-ling
出版日期:
2007
卷期:
24:6
頁次:
頁657-670
主題關鍵詞:
總額預算
;
共有資源悲劇
;
賽局理論
;
道德風險
;
風險選擇效果
;
Global budget
;
Tragedy of the commons
;
Game theory
;
Moral hazard
;
Risk selection
原始連結:
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相關次數:
被引用次數:期刊(
3
) 博士論文(0) 專書(0) 專書論文(0)
排除自我引用:
3
共同引用:
17
點閱:92
本文以賽局理論作為分析基礎,探究總額預算支付制度下,各醫療服務提供者的可能行為策略及其報酬組合,並比較均衡解下的醫療服務總量和整體醫療機構之最佳醫療服務量。最後探討總額預算支付制是否影響民眾就醫權利以及醫療服務品質。結果發現: 1.在靜態以及動態有限期雙人賽局的情況下,醫療機構選擇高服務量是優勢策略(dominant strategy)。但在動態無限期的雙人賽局中,亦即總額預算制度持續實施的情況下,若醫療提供者彼此間同儕制約的力量夠大時,則可達到(低服務量,低服務量)的子賽局精煉Nash均衡。 2.在多人單期賽局中,若健保局至少給付某最低點值以使醫療機構維持最基本的醫療品質時,則高服務量優勢策略下的醫療服務均衡總量大於整體醫療機構之最佳醫療服務量,而導致點值下降,形成共有資源悲劇。 3.若支付標準設計不當,易引發醫療機構的道德風險效果(moral hazard effect)和風險選擇效果(risk selection effect),使得醫療品質下降、醫療資源浪費並造成各醫療部門之發展嚴重扭曲的現象。
以文找文
The purpose of this paper is to characterize the Nash equilibrium service quantities under the global budget cap system using the game theoretical analysis. This paper investigates the provider's strategy under global budget cap with one-period, finite and infinite two-person game framework. In addition, we also employ multi-person game to compare the medical service quantities between the Nash equilibrium and the social optimum. Furthermore, this paper also explores the effects of the global budget cap system on the accessibility and quality of health care. Under the prospective payment system, the provider's total budget for the coming year is set in advance. The size of the budget represents a spending ceiling. Providers are allowed considerable flexibility to make decisions within the budget limit. According to a negotiated relative value scale, a point schedule is established assigning different points to the corresponding health care services. The budget is then divided by total points accumulated at the end of budget year and the relative value unit of health service is thus determined. Each provider's income is attained by multiplying his own accumulated points and the relative value unit given by the above calculation. It is obvious that the quantity decisions of all providers combined determine the relative value unit which is automatically reduced if every provider chooses to supply more health services. Thus, a provider aims at increasing his own profits by increasing health services quantities may results in an adverse consequences of decreasing profits due to the decreased relative value unit. A global budget creates an interest conflict among providers. The results of the model analysis are as follows: First, choosing high service quantities is the dominant strategy for health care providers under one-period and finite two-person game. Nonetheless, low service quantities may become the sub-game perfect Nash equilibrium under infinite repeated game with each provider implement Nash reversion strategy. Second, subject to the minimum value unit stipulated by the regulator, the dominant strategy of high service quantities results in larger service quantities and smaller value unit than those at collective optimum under one-period multi-person game. Finally, problems of moral hazard and risk selection may occur if the value unit as well as the points schedule is improperly designed. As a result, the quality of health care may be decreased, medical resources may be over utilized, and development for medical departments may be distorted seriously.
以文找文
期刊論文
1.
Robinson, James C.、Luft, Harold S.(1985)。The impact of hospital market structure on patient volume, average length of stay, and the cost of care。Journal of Health Economics,4(4),333-356。
2.
許碩芬、楊雅玲、陳和全(20070400)。社會困境?--全民健保總額預算制下醫療提供者策略的均衡分析。管理學報,24(2),155-165。
延伸查詢
3.
Newhouse, J. P.(1992)。Medical Care Costs: How Much Welfare Loss?。Journal of Economic Perspectives,6(3),3-21。
4.
陳欽賢、劉彩卿、林建仁、朱子斌、邱文達(20030900)。總額支付制度下醫院同儕行為之競合:賽局理論分析。醫務管理期刊,4(3),68-79。
延伸查詢
5.
陳順義、鄭文輝(20030500)。牙醫總額支付制度分區總額預算管理:中區與南區之比較。臺灣社會福利學刊,3,29-76。
延伸查詢
6.
Ellis, R. P.、McGuire, T. G.(1986)。Provider behavior under prospective reimbursement: Cost sharing and supply。Journal of Health Economics,5(2),129-151。
7.
Ellis, R. P.、McGuire, T. G.(1988)。Insurance principles and the design of prospective payment systems。Journal of Health Economics,7(3),215-237。
8.
Ellis, R. P.、McGuire, T. G.(1990)。Optimal payment systems for health services。Journal of Health Economics,9(4),375-396。
9.
Ellis, Randall P.、McGuire, Thomas G.(1993)。Supply-side and Demand-side Cost Sharing in Health Care。The Journal of Economic Perspectives,7(4),135-151。
10.
Fan, C. P.、Chen, K. P.、Kan, K.(1998)。The design of payment systems for physicians under global budget--an experimental study。Journal of Economic Behavior & Organization,34(2),295-311。
11.
Hurley, J.、Card, R.(1996)。Global Physician Budgets as Common Property Resources: Some Implications for Physicians and Medical Associations。Canadian Medical Association Journal,154(8),1161-1168。
12.
Lomas, Jonathan、Goldsmith, Laurie J.、Hurley, Jeremiah(1997)。Physician Responses to Global Physician Expenditure Budgets in Canada: A Common Property Perspective。The Milbank Quarterly,75(3),343-364。
13.
Ma, C. A.(1994)。Health Care Payment System: Cost and Quality Incentives。Journal of Economics & Management Strategy,3(1),93-112。
14.
Ma, C. A.、McGuire, T. G.(1997)。Optimal health insurance and provider payment。The America Economic Review,87(4),685-704。
15.
Mougeot, M.、Naegelen, F.(2005)。Hospital Price Regulation and Expenditure Policy。Journal of Health Economics,24(1),55-72。
16.
Anderson, G.、Lave, J.(1986)。Financing Graduate Medical Education Using Multiple Regression to Set Payment Rates。Inquiry,23,191-199。
17.
Barros, P. P.(2003)。Cream-skimming, Incentives for Efficiency and Payment System。Journal of Health Economics,22,419-443。
18.
Ellis, R. P.、Pope, G. C.、Iezzoni, L. I.、Ayanian, J. Z.(1996)。Diagnostic-based Risk Adjustment for Medical Capitation Payment。Health Care Financing Review,17(3),101-127。
19.
Terris, M.(1991)。Global Budgeting and the Control of Hospital Cost。Journal of Public Health Policy,12(1),61-71。
20.
Mcguire, T. G.、Pauly, M. V.(1991)。Physician Response to Fee Changes with Multiple Payers。Journal of Health Economics,10(4),385-410。
21.
Newhouse, J. P.(1996)。Reimbursing Health Plans and Health Providers, Efficiency in Production versus Selection。Journal of Economic Literature,34,1236-1263。
22.
Eggleston, K.(2000)。Risk Selection and Optimal Health Insurance-provider Payment System。The Journal of Risk and Insurance,67(2),173-194。
23.
Gertler, P. J.(1989)。Subsidies, Quality, and the Regulation of Nursing Homes。Journal of Public Economics,38(1),33-52。
24.
Dranove, D.、Sindelar, J.(1986)。The Effect of Injecting Price Competition into the Hospital Market, the Case of Preferred Provider Organizations。Inquiry,23,419-429。
25.
Joskow, P.(1980)。The Effects of Competition and Regulation on Hospital Bed Supply and the Reservation Quality of the Hospital。The Bell Journal of Economics,11,421-447。
26.
Sweeney, G. H.(1982)。The Market for Physician' Services, Theoretical Implications and an Empirical Test of the Target Income Hypothesis。Southern Economic Journal,48(3),594-613。
27.
Thorpe, K. E.(1988)。The Use of Regression Analysis to Determine Hospital Payment, the Case of Medicare's Indirect Teaching Adjustment。Inquiry - Blue Cross and Blue Shield Association,25(2),219-231。
圖書
1.
Gibbons, R.(1992)。Game Theory for Applied Economists。Princeton University Press。
2.
張維迎、劉楚俊(1999)。賽局理論與信息經濟學。臺北:茂昌圖書公司。
延伸查詢
其他
1.
(2003)。全民健康保險統計年報,0。
延伸查詢
圖書論文
1.
Cutler, D. M.、Zechkhauser, R. J.(2000)。The anatomy of health insurance。Handbook of Health Economics。North Holland:Elsevier Science。
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