An Exploration of Healthcare Providers' Point Rush Behavior and its Potential Risks under the DRG Points Approach
- VernacularTitle:DRG点数法下医疗机构冲点行为及其潜在风险探究
- Author:
Yu ZHANG
1
;
Dian ZHOU
;
Di TIAN
Author Information
1. 安徽医科大学卫生管理学院 安徽 合肥 230032
- Publication Type:Journal Article
- Keywords:
DRG;
point method;
point punching behavior;
potential risk;
game model
- From:
Chinese Hospital Management
2025;45(1):6-10
- CountryChina
- Language:Chinese
-
Abstract:
With the widespread implementation of the DRG point method in China,how to deal with the potential risks brought by the punching behavior of medical institutions under the point method is a real problem that needs to be solved.It explains the special characteristics of uncertainty in the distribution of health insurance fund under the DRG point method,and explores the possibility,feasibility and proliferation of the point flushing behavior of medical institutions under the DRG point method at the theoretical level based on the rational economic man perspective,the principal generation theory and the cohort effect.In response to the theoretical model,game theory is used to further construct a model of point-shuffling behavior of medical institutions under the DRG point method,and analyze the reasons for point-shuffling behavior and its potential risks.It is suggested that the potential risks of point-shaving can be prevented by strengthening the communication and cooperation between medical institutions under the medical association and hierarchical diagnosis and treatment system,and by implementing the monitoring mechanism of medical insurance government departments on medical institutions.
