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1、基于双边垄断模型的医疗服务医保支付标准研究倪沪平浙江大学公共管理学院医保部门与医院部门通过谈判,形成医疗服务医保支付标准,是未来屮国医改的发展趋势。医疗服务医保支付标准机制可分为医院部门占优、医保部门占优、医院和医保部门势均三种双边垄断市场结构进行研宄。从双边垄断模型看,医疗服务医保支付标准在医院部门占优情况下最高,而在医保部门占优情况下最低。过低或过高的医疗服务医保支付标准,都将不利于医院发展和参保人员福祉。医保部门和医院部门可以通过合作,最终形成协议价格,实现医疗服务社会福利最优。通过仿真模拟,揭示医疗服务医保支付标准、医疗服务数量、医保部门和医院部
2、门收益相对于单位医疗保险费、医疗资本和医生劳动投入、医院资本折旧、医生工资标准、医院资产投入和高端医疗设备更新速度等参数的变化规律。关键词:医疗服务;医疗保险;支付价格;双边垄断;金:国家社会科学棊金重大项A《人门老龄化与长寿风险管理的理论和政策研宄》(项目批准号43&ZD163)的阶段性研宄成果TheResearchaboutthePriceofMedicalInsurancePaymentforHealthServicesbasedonBilateralMonopolyModelNiHupingSchoolofPublicAffairs,Zhejia
3、ngUniversity;Abstract:ItisthefuturedevelopmenttrendofChina/smedicalreformthatmedicalinsurancesectorandhospitalsectorbethroughnegotiationsforformingthepriceofmedicalinsurancepaymentforhealthservices.Theresearchaboutthemedicarepayment’spricemechanismcanbedividedintothreekindsofbila
4、teralmonopolymarketstructure,thehospitalsectordominated,themedicalinsurancesectordominated,thehospitalandmedicalinsurancesectorevenlymatched.Basedonanalysisofbilateralmonopolymodel,medicarepaythehighestpriceofmedicalservicesinthesituationofhospitalsectordominated,thepaidpricebein
5、gminimuminthesituationofthehealthcaresectordominated.Excessivelyloworhighpricespaidbymedicaremedicalservices,benotconducivetothedevelopmentofthehospitalandtheinsuredbenefits.Thehealthinsurancesectorandhospitalsectorcancooperatetoformtheagreedprice,finally,achievingthebesthealthca
6、resocialwelfare.Throughsimulation,werevealthechange’slawaboutthepriceofmedicalservices,thequantityofmedicalservices,andthegainsofthehealthcaresectorandthehospitalsector,withrespecttotheparametersabouttheunitmedicalinsurance,medicalcapitalanddoctors’laborinputs,hospital’scapitalde
7、preciation,doctors’wage,hospital’sassetinvestment,therenewalrateofthehigh-endmedicalequipment.Keyword:medicalservice;medicalinsurance;thepriceofmedicalinsurancepayment;bi1ateralmonopoly;极推动建立医疗保险机构与医疗机构之间谈判机制,是我国“十二五”期间深化医药卫生体制改革的重要内容。2015年,国家发展改革委进一步提出推动医药和医疗服务医保支付标准改革。相比医保药品价格改
8、革而言,由于医疗服务的特殊性,建立医疗服务医保支付标准机制的难度更大。加快建立由