我国医疗市场医师过度医疗行为约束机制的博弈分析

摘要

OBJECTIVE:To investigate the constraint mechanism on excessive medical behavior of doctors in Chinese medical market. METHODS:Under certain assumptions(suppose the hospital and the doctor's demands are consistent,the government and the patient's demands are consistent,etc),mixed game method(game theory)was used to analyze Nash equilibrium between government and doctors,between patients and doctors.The qualitative analysis was performed for these constraints based on the re-ality. RESULTS&CONCLUSIONS:The strict punishing mechanism and the choice right to doctor of patients and public satisfac-tion with the government can achieve the Nash equilibrium of game and effectively inhibit excessive medical behavior. The govern-ment should create a competitive environment to enhance the right of patients to select doctor and improve the relevant legal system on the basis of promoting incentive compatibility among all parties so as to strengthen the implementation of supervision. At the same time,the government should establish credit archives of the doctor to form effective reputation incentive mechanism to doc-tors,and proactively explore the patients participation mechanism based on reducing the cost of patient participation.%目的:探讨我国医疗市场医师过度医疗行为的约束机制.方法:在一定的假设条件下(假定医院和医师的诉求一致、政府和患者的诉求一致等),应用混合策略(博弈论)方法分别分析政府和医师、患者和医师行为的纳什均衡条件,并结合现实情况对这些约束条件进行定性分析.结果与结论:加大对医师过度医疗行为的惩罚力度、提高患者的择医权和引入公众对政府满意度评价,能实现博弈的纳什均衡并能有效抑制过度医疗.政府应营造竞争环境来加强患者的择医权,并在促进各方激励相容的基础上,完善相关的法制建设以增强监督的执行力度;同时应建立医师诚信档案以形成有效的医师声誉激励机制,并积极探索以减少参评成本为基础的患者参评机制.