药占比管制下过度医疗行为多阶段动态演化研究

doi:10.16381/j.cnki.issn1003-207x.2022.1780

Abstract

Abstract:

Over-treatment is one of the key issues in China's medical reform. Following the abolition of medication bonus measures to prevent doctors from overusing medications， problems such as over-examination and over-treatment have become increasingly serious.A multi-stage dynamic evolution game model of doctor-patient behavior is constructed under the control of drug ratio， and the evolution of the behavior strategy of the three participants of doctors and patients is discussed by replicating the Jacobi matrix and numerical experiment simulation of the dynamic system.The results are as follows.（1）The assessment and incentive of doctors' non-drug expenses by the hospital is an important reason for the problems of excessive examination and over-treatment of doctors.The poor channels for patient complaints have contributed to the problem of over-examination and over-treatment by doctors. （2）In the two-way game between doctors and patients without hospital participation， drug proportion control is not always conducive to curb excessive medical problems， but in the three-way game between doctors and patients with hospital participation and patients having channels to review medical plans， drug proportion control is always conducive to curb excessive medical problems. （3）When the reference value of drug proportion is small， the hospital should take incentive measures for doctors who exceed the standard drug proportion control documents， and when the reference value of drug proportion is large， the hospital should take punitive measures against doctors who use drugs beyond the standard. （4）Mild patients and patients with low treatment cost will be treated differently by doctors. Doctors tend to provide excessive medical schemes for patients with low treatment cost， but tend to provide reasonable medical schemes for mild patients， and patients with low treatment cost can only be forced to accept it. Therefore， The hospital should use the limited review cost to focus on the review of medical plans for patients with low treatment cost but serious diseases. （5）The high complaint cost of patients reduces the willingness of patients to accept the medical scheme provided by doctors， and is not conducive to the promotion and popularization of the first diagnosis at the grass-roots level. Therefore， the hospital should actively review the medical scheme provided by doctors， and establish a transfer payment mechanism for excessive medical punishment to compensate patients for their losses， so as to realize mutual trust between doctors and patients.

Key words: drug-proportion regulation, over-treatment, tripartite evolutionary game, multi-stage dynamic game, mechanism of transfer payment

CLC Number:

C934

Xiangyan Sun,Xinchi Qu. Multi-stage Dynamic Evolution of Over-treatment Behavior under Drug-proportion Regulation[J]. Chinese Journal of Management Science, 2024, 32(8): 308-321.

Figures/Tables 16

医生	患者	患者	医生	院方
合理方案 ( $x$ )	接受( $y$ )	$u - a θ - b θ - ρ c 2$	$- c 1 + δ b θ + k η - a a + b$	$S - k η - a a + b - ρ c 31$
合理方案 ( $x$ )	拒绝( $1 - y$ )	$- h$	$- c 3$	$0$
过度方案 ( $1 - x$ )	接受( $y$ )	$u - a θ - b θ + ρ λ e - c 2 + e - e$	$- 1 + α c 1 + δ b θ + k η - a θ a θ + b θ + e - ρ λ e + 1 - ρ δ e$	$S - k η - a θ a θ + b θ + e - ρ S + S f + c 31$
过度方案 ( $1 - x$ )	拒绝( $1 - y$ )	$0$	$- 1 + α c 3$	$0$

医生	患者	患者	医生	院方
合理方案 ( $x$ )	接受( $y$ )	$u - a θ - b θ - ρ c 2$	$- c 1 + δ b θ + k η - a a + b$	$S - k η - a a + b - c 31$
合理方案 ( $x$ )	拒绝( $1 - y$ )	$- h$	$- c 3$	$- c 31$
过度方案( $1 - x$ )	接受( $y$ )	$u - a θ - b θ + ρ λ e - c 2$	$- 1 + α c 1 + δ b θ + k η - a θ a θ + b θ + e - λ e$	$S - k η - a θ a θ + b θ + e - c 31$
过度方案( $1 - x$ )	拒绝( $1 - y$ )	$0$	$- 1 + α c 3 - c 4$	$- c 31 + c 4$

均衡点	特征值 $λ 1$	特征值 $λ 2$	特征值 $λ 3$
$E 1 0,0, 0$	$u - p r - ρ c 2 - 1 - ρ 1 + λ e$	$α c 3$	$c 4 - c 31$
$E 2 0,0, 1$	$u - p r - ρ c 2 + ρ λ e$	$α c 3 + c 4$	$- c 4 - c 31$
$E 3 0,1, 0$	$u - p r - ρ c 2 + h$	$- α c 3$	$- c 31$
$E 4 0,1, 1$	$u - p r - ρ c 2 + h$	$- α c 3 + c 4$	$c 31$
$E 5 1,0, 0$	$p r + ρ c 2 + 1 - y 2 e - u - y 2 λ e$	$ρ λ e + α c 1 - 1 - ρ δ e + L$	$ρ S + S f + ρ - 1 c 31$
$E 6 1,0, 1$	$- u - p r - ρ c 2 + ρ λ e$	$λ e + α c 1 + L$	$- ρ S + S f + ρ - 1 c 31$
$E 7 1,1, 0$	$- u - p r - ρ c 2 + h$	$- ρ λ e + α c 1 - 1 - ρ δ e + L$	$ρ - 1 c 31$
$E 8 1,1, 1$	$- u - p r - ρ c 2 + h$	$- λ e + α c 1 + L$	$1 - ρ c 31$
$E 9 y 1 , x , z *$	鞍点

均衡点	$u + ρ λ e < p r + ρ c 2$				$u - p r - ρ c 2 - 1 - ρ 1 + λ e < 0 < u + ρ λ e - p r - ρ c 2$				$u - p r - ρ c 2 - 1 - ρ 1 + λ e > 0$
	$λ 1$	$λ 2$	$λ 3$	稳定性	$λ 1$	$λ 2$	$λ 3$	稳定性	$λ 1$	$λ 2$	$λ 3$	稳定性
$E 1 0,0, 0$	-	+	+	非稳定点	-	+	+	非稳定点	+	+	+	鞍点
$E 2 0,0, 1$	-	+	-	非稳定点	+	+	-	非稳定点	+	+	-	非稳定点
$E 3 0,1, 0$	-	-	-	ESS	-	-	-	ESS	-	-	-	ESS
$E 4 0,1, 1$	-	-	+	非稳定点	-	-	+	非稳定点	-	-	+	非稳定点
$E 5 1,0, 0$	+	+，-	+，-	非ESS	+	+，-	+，-	非ESS	-	+，-	+，-	待定
$E 6 1,0, 1$	+	+，-	-，+	非ESS	-	+，-	-，+	待定	-	+，-	-，+	待定
$E 7 1,1, 0$	+	-，+	-	非ESS	+	-，+	-	非稳定点	+	-，+	-	非ESS
$E 8 1,1, 1$	+	-，+	+	非ESS	+	+，-	+，-	非ESS	+	+，-	+，-	非ESS
$E 9 y 1 , x , z *$	$D e t < 0, T r J = 0$			鞍点	$D e t < 0, T r J = 0$			鞍点	$D e t < 0, T r J = 0$			鞍点

均衡点	$ρ λ e + α c 1 + L > 1 - ρ δ e$				$ρ λ e + α c 1 - 1 - ρ δ e + L < 0 < λ e + α c 1 + L$				$λ e + α c 1 + L < 0$
	$λ 1$	$λ 2$	$λ 3$	稳定性	$λ 1$	$λ 2$	$λ 3$	稳定性	$λ 1$	$λ 2$	$λ 3$	稳定性
$E 1 0,0, 0$	-，+	+	+	非ESS	-，+	+	+	非ESS	-，+	+	+	非ESS
$E 2 0,0, 1$	-，+	+	-	非稳定点	-，+	+	-	非稳定点	-，+	+	-	非稳定点
$E 3 0,1, 0$	+	-	-	非稳定点	+	-	-	非稳定点	+	-	-	非稳定点
$E 4 0,1, 1$	+	-	+	非稳定点	+	-	+	非稳定点	+	-	+	非稳定点
$E 5 1,0, 0$	+，-	+	+，-	非ESS	+，-	-	+，-	待定	+，-	-	+，-	待定
$E 6 1,0, 1$	+，-	+	-，+	非ESS	+，-	+	-，+	非ESS	+，-	+，-	-，+	待定
$E 7 1,1, 0$	-	-	-	稳定点	-	+	-	非稳定点	-	+	-	非稳定点
$E 8 1,1, 1$	-	-	+	非稳定点	-	-	+	非稳定点	-	-，+	+	非稳定点
$E 9 y 1 , x , z *$	$D e t < 0, T r J = 0$			鞍点	$D e t < 0, T r J = 0$			鞍点	$D e t < 0, T r J = 0$			鞍点

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Multi-stage Dynamic Evolution of Over-treatment Behavior under Drug-proportion Regulation

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