Evolutionary game and simulation analysis of add-on payment policy under DRG payment reform in China
- VernacularTitle: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
- Author:
Ye CHEN
1
;
Jiaming LI
1
;
Fenghong YANG
2
;
Wei LI
2
Author Information
1. School of International Pharmaceutical Business，China Pharmaceutical University，Nanjing 211198，China;Market Access Policy Research Center，China Pharmaceutical University，Nanjing 211198，China
2. School of International Pharmaceutical Business，China Pharmaceutical University，Nanjing 211198，China
- Publication Type:Journal Article
- Keywords:
add-on payment;
DRG payment;
innovative technology;
evolutionary game;
medical insurance payment
- From:
China Pharmacy
2025;36(22):2753-2759
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To provide reference for the establishment and optimization of add-on payment policy in China. METHODS The two-party evolutionary game model was constructed， involving medical insurance and medical institutions，and simulation experiments were conducted. The effects of factors such as whether the establishment of add-on payment policy by the medical insurance department， the compensation ratio， and the cost and incremental utility of new technology on the adoption of innovative technologies by medical institutions were analyzed under the backdrop of the reform of the diagnosis-related groups （DRG） payment system. RESULTS & CONCLUSIONS The add-on payment policy can effectively incentivize the utilization of innovative technologies， but it also carries the risk of overuse or misuse of new technologies. The compensation ratio， unit price of new technology， and cost savings derived from the improved effectiveness of new technologies， as well as the incremental utility of new technology， will all affect the equilibrium state of the evolutionary game， potentially even reversing it. It is recommended to optimize the selection criteria for the scope of add-on payment， so as to incentivize the use of innovative technologies while controlling the risk of their misuse. Additionally， a reasonable approach should be taken to adopt either standalone payment or supplementary payment models based on the surplus level of medical insurance funds in the coordinated regions. Meanwhile， a regular adjustment mechanism should be established to ensure smooth integration between the add-on payment and the DRG payment system.
