信息不对称下的医疗服务市场分析
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摘要
随着2009年新医改方案的出台,我国的医疗卫生体制改革进入新一轮探索中,而解决医疗服务市场的信息不对称以及由此导致的各种矛盾成为理论界和医疗服务市场各方主体共同探讨和关心的话题。医疗服务市场的特殊性集中表现为“信息不对称”,即医患之间的信息不对称、医疗服务机构与监管机构的信息不对称等。医疗服务具有很强的知识性、专业性和技术性,社会分工和专业化导致医患双方获得信息的能力不对等,这是医患信息不对称的主要原因,此外医疗信息搜寻成本过高、信息传递的闭塞以及信息披露制度的缺失是加剧信息不对称的主要原因。
我国医疗服务市场的信息高度不对称导致了现实中一系列严重的问题,首先,信息不对称导致逆向选择的出现,表现为“小病大医”,医疗资源配置出现扭曲,逆向选择还会导致“低质量医疗服务机构驱逐高质量医疗服务机构”的现象,其次,信息不对称还会引发“道德风险”问题,不仅破坏了医疗服务市场的均衡还导致了市场的低效率,医生在治疗患者的过程中拥有绝对的决策权和控制权,在利益的驱使下,医生诱导患者“大开处方、开贵药、增设检查项目”,导致过度医疗,最终导致了百姓“看病难、看病贵”的社会问题。为了分析和解决现实问题,本文运用博弈论的方法构建医方与患者的博弈模型,证明了在信息不对称的条件下医方出现“诱导需求“的必然性。这种过度医疗严重损害了患者的利益,同时医方与监管部门的博弈情况也在很大程度上影响患者的利益。只有政府监管部门加大监管和惩罚力度,医方才会降低发生道德风险的可能性。因此加强监管是当前需要解决的重要问题。
最后,本文提出了解决医疗服务市场信息不对称的对策建议,这是本篇文章的重点,希望能够给正在推进的新医改提供一些借鉴。第一,建立以“公立医院为主、营利性医院为辅”的医疗服务体系,在保证广大人民群众健康的条件下,加强市场化进程;第二,建立网络信息服务平台,推进医疗信息公示制度的建立,加快远程医疗的发展;保证信息流通渠道的畅通,为医疗落后的偏远地区患者排忧解难;第三,推进医药流通体制改革,从根源上打破“以药养医”的局面,彻底切断医方与药品生产厂商的联系,防止道德风险的发生;第四,建立新型的医院盈利模式和医生的薪酬体系,适当提高医务费的标准,建立以“医务费”为中心的补偿机制;第五,建立多方参与的医疗服务监管体系,建立政府主导、医疗行业协会和广大患者踊跃参与的医疗服务监管体系;第六,以“美国的新医改”为例,分析出美国采用征收“医改税”方法割裂了医疗保险公司与药品生产企业的联系,形成了一个良性的循环机制,即降低了企业的负担又能让美国民众享用到便宜的医疗服务,我国的新医改也要借鉴这种理念来探索我国新医改的道路;第七,高州模式为县级医院的医疗改革提供了指导价值和借鉴价值,我们应该学习高州模式的理念,应该以“一切为人民看得起病”为核心。
With the introduction of the new healthcare reform plan in 2009, health system reform in China entered a new round of exploration. Solving the health care market information asymmetry and the resulting contradictions is the main topic of concern in theories and health services in the market. We special focus on the medical service market performance of“asymmetric information”, the information asymmetry between doctors and patients, health care institutions and regulatory bodies. Medical services have the characteristics of knowledgeable professional and technical. Social division of labor and specialization led to the ability of both doctors and patients that access to information asymmetry, which is the main reason for patient information asymmetry. Besides the high cost of searching information, information delivery system of occlusion and the lack of information disclosure are the main reasons for information asymmetry.
A high degree of asymmetry of information in China medical service market leads to a serious problem in reality. First, information asymmetry causes adverse selection and the performance of“Medicine for minor illnesses”. Allocation of medical resources is distorted; adverse selection also leads to“expulsion of low-quality health care services to quality heath services”; second, the information asymmetry also leads to“moral hazard”problem, this not only undermined the balance of the medical service market has but also led to market inefficiencies. Doctors have the power of making decision and absolute control over the patients in the process of treating patients. Driven by interests, the doctor induced patients to“large prescription, open expensive medicine, an additional check items”, resulting in excessive medical treatment, eventually leading to a social issue----“difficult and expensive to see the doctors”. In order to analyze and solve practical problems, I use game theory to construct game model between the patient and the doctor. Under conditions of asymmetric information, an“induced demand”from medical side is the inevitable. This kind of over-treatment seriously damage to the interests of patients. The medical situation in the game with the regulatory authorities also largely affected the welfare of patients. If government regulators increase regulation and punishment, doctors will reduce the possibility of moral hazard, thus enhancing the regulation is an important issue to be resolved.
Finally, this paper proposes the suggestions which solve the health care market information asymmetry. This is the focus of this article, hoping to provide some reference for the new health care reform. First, we shall establish a health care service system of public hospital-based, for-profit hospitals supplemented. In ensuring the health of the masses under the conditions, we should strengthen the process of market. Second, establishing a network information service platform is important. We should promote to establish a new public system of medical information, accelerating the development of telemedicine. This ensures the smooth flow of information distribution channels, especially for medical patients in remote areas. Third, the government should promote the pharmaceutical distribution system, which break from the roots“to drugs to support medical”situation, this also cut off the contact with medical side and pharmaceutical manufacturers. So moral hazard is prevented. Fourth, establishing a new profit model of hospitals and doctors pay system is practicable. We should appropriately increase the standard of medical fees, and establish a“medical expenses”as the center of the compensation mechanism. Fifth, the establishment of a participatory monitoring system for medical services is needed;we should establish a health care regulatory system which a government-led , health care industry associations and the majority of patients take part in. Sixth, I use the“America’s new health care reform”as an example of the United States by levying a“healthcare tax”approach which separates the medical insurance companies and pharmaceutical manufacturers of contact, forming a virtuous cycle mechanism. This approach not only reduces the burden on businesses but also make the American people enjoy cheaper medical services. China’s new health care reform should draw on this concept to explore the road of new health care reform. Seventh, Gaozhou model provide a guiding value and reference value for the reform of county hospitals. We should learn the concept of Gaozhou model. China’s new health care reform should be based on“all the people can afford medical”as the core.
我国医疗服务市场的信息高度不对称导致了现实中一系列严重的问题,首先,信息不对称导致逆向选择的出现,表现为“小病大医”,医疗资源配置出现扭曲,逆向选择还会导致“低质量医疗服务机构驱逐高质量医疗服务机构”的现象,其次,信息不对称还会引发“道德风险”问题,不仅破坏了医疗服务市场的均衡还导致了市场的低效率,医生在治疗患者的过程中拥有绝对的决策权和控制权,在利益的驱使下,医生诱导患者“大开处方、开贵药、增设检查项目”,导致过度医疗,最终导致了百姓“看病难、看病贵”的社会问题。为了分析和解决现实问题,本文运用博弈论的方法构建医方与患者的博弈模型,证明了在信息不对称的条件下医方出现“诱导需求“的必然性。这种过度医疗严重损害了患者的利益,同时医方与监管部门的博弈情况也在很大程度上影响患者的利益。只有政府监管部门加大监管和惩罚力度,医方才会降低发生道德风险的可能性。因此加强监管是当前需要解决的重要问题。
最后,本文提出了解决医疗服务市场信息不对称的对策建议,这是本篇文章的重点,希望能够给正在推进的新医改提供一些借鉴。第一,建立以“公立医院为主、营利性医院为辅”的医疗服务体系,在保证广大人民群众健康的条件下,加强市场化进程;第二,建立网络信息服务平台,推进医疗信息公示制度的建立,加快远程医疗的发展;保证信息流通渠道的畅通,为医疗落后的偏远地区患者排忧解难;第三,推进医药流通体制改革,从根源上打破“以药养医”的局面,彻底切断医方与药品生产厂商的联系,防止道德风险的发生;第四,建立新型的医院盈利模式和医生的薪酬体系,适当提高医务费的标准,建立以“医务费”为中心的补偿机制;第五,建立多方参与的医疗服务监管体系,建立政府主导、医疗行业协会和广大患者踊跃参与的医疗服务监管体系;第六,以“美国的新医改”为例,分析出美国采用征收“医改税”方法割裂了医疗保险公司与药品生产企业的联系,形成了一个良性的循环机制,即降低了企业的负担又能让美国民众享用到便宜的医疗服务,我国的新医改也要借鉴这种理念来探索我国新医改的道路;第七,高州模式为县级医院的医疗改革提供了指导价值和借鉴价值,我们应该学习高州模式的理念,应该以“一切为人民看得起病”为核心。
With the introduction of the new healthcare reform plan in 2009, health system reform in China entered a new round of exploration. Solving the health care market information asymmetry and the resulting contradictions is the main topic of concern in theories and health services in the market. We special focus on the medical service market performance of“asymmetric information”, the information asymmetry between doctors and patients, health care institutions and regulatory bodies. Medical services have the characteristics of knowledgeable professional and technical. Social division of labor and specialization led to the ability of both doctors and patients that access to information asymmetry, which is the main reason for patient information asymmetry. Besides the high cost of searching information, information delivery system of occlusion and the lack of information disclosure are the main reasons for information asymmetry.
A high degree of asymmetry of information in China medical service market leads to a serious problem in reality. First, information asymmetry causes adverse selection and the performance of“Medicine for minor illnesses”. Allocation of medical resources is distorted; adverse selection also leads to“expulsion of low-quality health care services to quality heath services”; second, the information asymmetry also leads to“moral hazard”problem, this not only undermined the balance of the medical service market has but also led to market inefficiencies. Doctors have the power of making decision and absolute control over the patients in the process of treating patients. Driven by interests, the doctor induced patients to“large prescription, open expensive medicine, an additional check items”, resulting in excessive medical treatment, eventually leading to a social issue----“difficult and expensive to see the doctors”. In order to analyze and solve practical problems, I use game theory to construct game model between the patient and the doctor. Under conditions of asymmetric information, an“induced demand”from medical side is the inevitable. This kind of over-treatment seriously damage to the interests of patients. The medical situation in the game with the regulatory authorities also largely affected the welfare of patients. If government regulators increase regulation and punishment, doctors will reduce the possibility of moral hazard, thus enhancing the regulation is an important issue to be resolved.
Finally, this paper proposes the suggestions which solve the health care market information asymmetry. This is the focus of this article, hoping to provide some reference for the new health care reform. First, we shall establish a health care service system of public hospital-based, for-profit hospitals supplemented. In ensuring the health of the masses under the conditions, we should strengthen the process of market. Second, establishing a network information service platform is important. We should promote to establish a new public system of medical information, accelerating the development of telemedicine. This ensures the smooth flow of information distribution channels, especially for medical patients in remote areas. Third, the government should promote the pharmaceutical distribution system, which break from the roots“to drugs to support medical”situation, this also cut off the contact with medical side and pharmaceutical manufacturers. So moral hazard is prevented. Fourth, establishing a new profit model of hospitals and doctors pay system is practicable. We should appropriately increase the standard of medical fees, and establish a“medical expenses”as the center of the compensation mechanism. Fifth, the establishment of a participatory monitoring system for medical services is needed;we should establish a health care regulatory system which a government-led , health care industry associations and the majority of patients take part in. Sixth, I use the“America’s new health care reform”as an example of the United States by levying a“healthcare tax”approach which separates the medical insurance companies and pharmaceutical manufacturers of contact, forming a virtuous cycle mechanism. This approach not only reduces the burden on businesses but also make the American people enjoy cheaper medical services. China’s new health care reform should draw on this concept to explore the road of new health care reform. Seventh, Gaozhou model provide a guiding value and reference value for the reform of county hospitals. We should learn the concept of Gaozhou model. China’s new health care reform should be based on“all the people can afford medical”as the core.
引文
[1] J.E.Stiglitz.Economics of The Public Sector(2“edition)[M].New York:W.W.Norton& Company,1988:293-294
[2]Martin S﹒Feldstein. The Rising Price of Physicians Services .[J].The Review of Economics and Statistics.1970 (52: 121-133)
[3]董恒进.医院管理学[M].上海:复旦大学出版社,2002,237-243
[4]张常明.医患关系的卫生经济学考明[J].临床误诊误治,2001,14(4:11-14)
[5]蒋天文,樊志宏.中国医疗系统的行为扭曲机理与过程分析[J],经济研究.2002,1l:71.80
[6]赵曼.社会医疗保险费用约束机制与道德风险规避[J].财贸经济,2003(2):54—57
[7] Fuch,Victor R.The Future of Health Economics[J].Journal of Health Economics,2000(19):141-157
[10]夏琪:《信息不对称下医疗服务博弈分析》鄂州大学学报2008年(1)
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[2]Martin S﹒Feldstein. The Rising Price of Physicians Services .[J].The Review of Economics and Statistics.1970 (52: 121-133)
[3]董恒进.医院管理学[M].上海:复旦大学出版社,2002,237-243
[4]张常明.医患关系的卫生经济学考明[J].临床误诊误治,2001,14(4:11-14)
[5]蒋天文,樊志宏.中国医疗系统的行为扭曲机理与过程分析[J],经济研究.2002,1l:71.80
[6]赵曼.社会医疗保险费用约束机制与道德风险规避[J].财贸经济,2003(2):54—57
[7] Fuch,Victor R.The Future of Health Economics[J].Journal of Health Economics,2000(19):141-157
[10]夏琪:《信息不对称下医疗服务博弈分析》鄂州大学学报2008年(1)
[1]David Hemenway.Demand Inducement and the Physician-Patient Relationship[J].1988(02).
[2]J.E.Stiglitz.Economics of The Public Sector(2“edition”)[M].New York:W.W.Norton& Company,1988:293-294.
[3]Kenneth Joseph Arrow.Uncertainty and the Welfare Economics of Medical Care[J].Journal of Health Politics,PolicyandLaw.2001-6(5):851-883.
[4]Martin S.Feldstein.The Rising Price of Physicians Services[J].The Review of Economics and Statistics.1970(52):121-133.
[5]Robet G Evans.Supplier Induced Demand:Some Empirical Evidence and Implications.The Economics of Health and Medical Care[M].New York:Heal stead Press,1974:162-173.
[6]V R.Fuchs. The Supply of surgeons and the Demand for Operations [J].Journal of Human Resources,1978,13(Supplement):35-38.
[7]陈柳宇.我国药价虚高现象的三重因素分析——信息不对称、委托代理与需求价格弹性.社会工作[J].2007(6)下59-61.
[8]陈永升.医疗保险中医疗供方道德风险行为分析[J].新疆财经学院学报,2002,(4):35-37.
[9]董恒进.医院管理学[M].上海:复旦大学出版社,2002,237-243.
[10]方永丽,曹素娜.我国医疗市场信息不对称问题及对策探索[J].管理与财富,2009(7):113.
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