DRG付费改革背景下我国除外支付政策的演化博弈与仿真分析

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中图分类号R95;R197 文献标志码A 文章编号 1001-0408（2025）22-2753-07

DOI 10.6039/j.issn.1001-0408.2025.22.01

ABSTRACTOBJECTIVEToprovidereference fortheestablishmentandoptimizationofadd-onpayment policyin China. METHODS The two-partyevolutionarygame modelwasconstructed，involving medical insuranceand medical institutions，nd simulationexperimentswereconducted.Theefectsoffactorssuchaswhethertheestablishmentofadd-onpaymentpolicybythe medicalinsurancedepartment，thecompensationratio，andthecostandincrementalutilityofnewtechnologyontheadoptionof inovativetechnologiesbymedicalinstitutionswereanalyzedunderthebackdropofthereformofthediagnoss-relatedgroups （DRG）payment system.RESULTS & CONCLUSIONS The add-on payment policy can efectively incentivize the utilization of inovativetechnologies，butitalsocarriestheriskofoveruseormisuseofnewtechnologies.Thecompensationratio，unitpriceof newtechnology，andcostsavingsderivedfromteimprovedefectivenessofnewtechnologies，asellastheincrementauilityof newtechnology，willallaectthequilibiumstateoftheevolutionarygame，potentiallyeveneversingit.Itisecomededt optimizetheselectioncriteriaforthescopeofadd-onpayment，soastoincentivizetheuseof innovativetechnologieswhile controlingtheriskof theirmisuse.Additionally，areasonableapproachshouldbetaken toadopteitherstandalonepaymntor supplementarypayment models basedonthesurplus level of medical insurance funds in thecoordinated regions.Meanwhile，a regularadjustment mechanismshould beestablished toensure smooth integration between theadd-on paymentandtheDRG payment system.

KEYWORDSadd-on payment；DRG payment；inovativetechnology；evolutionarygame；medical insurance payment; influential factors

2020年，《中共中央国务院关于深化医疗保障制度改革的意见》明确指出，要持续推进医保支付方式改革，推广按疾病诊断相关分组（diagnosis-relatedgroups，DRG）付费。（剩余14766字）