ABSTRACT
As the major means of outpatient payment for basic medical insurance (the insurance for short) relies on fee-for-service, it tends to encourage unreasonable growth of medical expenses. Based on the principal-agent theory, this paper analyzed the principal-agent relationship between the insurance handling agencies and the hospitals designated by the insurance, and constructed a benefit game model of outpatient payment methods and the supporting supervision game model. This practice aims to explore the optimal and balanced benefit of the insurance payment methods and supporting supervision mechanism, and provide decision support for promoting the reform of medical insurance outpatient payment in China. The analysis results of the benefit game model of payment methods showed that a system mixing the post-payment and pre-payment could optimize and maximize the total benefits and interests of all the stakeholders within the system. Specifically, the practice recommended was a mixed payment integrating ambulatory-payment-classification, fee-for-service and global-budget-payment. The analysis of the supporting regulatory game model found that the factors that must be considered to ensure the expected utility of the above mixed payment mode as follows: the gap between the unreasonable income obtained by the hospital by out-of-control charging and the reward obtained by under-control charging, the size of the penalty after the unreasonable income of the hospital was discovered, the size of the regulatory cost and the loss of benefits of the government and the insured group. It is suggested to adopt the mixed payment method mainly based on the ambulatory-payment-classification supported by fee-for-service and global-budget. At the same time, medical insurance agencies can improve their supervision mechanism from such aspects as perfecting penalties, reducing supervision costs, leveraging government administrative power and advocating public supervision.
ABSTRACT
Integration of healthcare and prevention is key path to achieving the pattern of " macro healthcare, macro health". However, it is hard at present to fully integrate healthcare and prevention in China, mostly due to the lack of effective incentive compatibility strategies. Based on the incentive compatibility theory, this study proposed a multi-level principal-agent chain of healthcare and prevention integration. Taking the incentive transmission among stakeholders in the principal-agent chain as the analysis framework, the dilemma and causes of incentive incompatibility of healthcare and prevention integration were studied.Combined with the proctice of healthcare and prevention integration in Sanming city, the incentive compatibility strategies of healthcare and prevention integration were proposed at the level of government, medical institutions, medical staff, public health staff and residents. These strategies refer to coordinating the use of medical insurance funds and public health funds, strengthening organization management as well as assessment and incentive, rewarding health promotion management points, and setting up health science popularization teams.
ABSTRACT
Resumo: A literatura concernente ao Programa Bolsa Família tem focado questões como o impacto sobre a pobreza e a desigualdade, os efeitos relacionados com o processo eleitoral e a função das condicionalidades. Entretanto, o Programa Bolsa Família está também associado a um problema de relação principal-agente, pois requer o controle efetivo de um conjunto de regras para seu funcionamento. Na literatura nacional, pouco se tem produzido sobre o efeito de regras formais como instrumentos de modelagem comportamental dos atores políticos. Propõe-se aqui explorar o papel das burocracias federal e municipal na gestão de políticas públicas em uma federação altamente descentralizada. Para testar como fatores de natureza política, institucional e geográfica influenciam a gestão intersetorial do programa, o estudo usa modelos de regressão linear múltipla para uma análise comparada entre cerca de 5.500 municípios. Os resultados apontam que variáveis como competição política e localização regional impactam positivamente a qualidade da gestão. O estudo conclui que a aplicação efetiva de regras foi determinante para gerar um aprendizado institucional entre os atores da política.
Resumen: La literatura sobre el Programa Bolsa Familia se ha centrado en cuestiones tales como el impacto sobre la pobreza y la desigualdad, los efectos relacionados con el proceso electoral y el papel de las condicionalidades. Sin embargo, el Programa Bolsa Familia también está asociado con un problema de la relación principal-agente, se requiere un control eficaz de un conjunto de reglas para su funcionamiento. En la literatura nacional, poco se ha hecho de los efectos de las reglas formales como instrumentos de modelización del comportamiento de los actores políticos. Se propone aquí explorar el papel de las burocracias federal y municipal en la gestión de las políticas públicas en una federación altamente descentralizada. Para probar cómo factores de naturaleza política, institucional y geográfica influyen en la gestión intersectorial del programa, lo estudio utiliza múltiples modelos de regresión lineal para un análisis comparativo entre aproximadamente 5.500 municipios. Los resultados muestran que las variables tales como la política de competencia y la ubicación regional tienen un impacto positivo en la calidad de la gestión. El estudio concluye que la aplicación efectiva de las normas era crucial para generar un aprendizaje institucional entre los actores de la política.
Abstract The literature on the Bolsa Família Program has focused on issues such as the impact on poverty and inequality, the effects related to the electoral process and the role of conditionalities. However, the Bolsa Família Program is also associated with a problem of principal-agent relationship, because it requires the effective control of a set of rules for its operation. In the national literature, little has been produced on the effect of formal rules as instruments for political actors' behavioral modeling. The proposal here is to explore the role of the federal and local bureaucracies in public policies management in a highly decentralized federation. In order to test how factors of policy, institutional and geographical nature influence the intersectoral management of the program, the study uses multiple linear regression models for a comparative analysis between about 5.500 cities. The results show that variables such as political competition and regional location positively impact the quality of management. The study concludes that the effective application of rules was crucial to generate institutional learning among actors involved in the policy.
Subject(s)
Poverty , Public Policy , Family , Organizational PolicyABSTRACT
On the basis of principal-agent theory,this paper analyzed the reasons of doctor-patient problems from the perspective of patients and hospitals,hospitals and physicians,and patients and physicians.It included asymmetric medical information,ethical risks of physicians,incomplete contracts between physicians and patients,and uncertainty of medical results.Aimed at these problems,this paper put forward relevant suggestions.In the view of recognition,patients are supposed to get a rational idea in the process of selecting hospitals and try making a contract with general practitioners.In the view of improvement,the pattern of performance assessment to physicians should be developed.In the view of system,the corresponding management measures of health service should be improved so as to better serve patients.
ABSTRACT
Based on a review of literature and the current reform of public hospital corporate governance,such corporate governance is divided intocombined regulation and operation,anddivided regulation and operationmodels.Then the principal-agent theory was called into play to analyze the main problems and causes of the existing models.From the perspectives of government supervision and assessment,professionalization of hospital directors,market competition mechanism,thoughts were made on how to improve such corporate governance.
ABSTRACT
There is a high degree of information asymmetry in medical services.Public hospitals are characteristic of the nature of multi-layer principal-agent relationships.Asymmetric information can lead to inconsistent value goals between the principal and the agent,giving birth to the government regulation capture as a result.Such capture ranks a fundamental cause for diluted public welfare nature of public hospitals.To offset such capture at public hospitals calls for reconstruction of government regulation system within the framework of public hospital corporate governance at an institution level.It is also necessary to eliminate the information asymmetry and its negative results,bringing public hospitals back on track to public welfare.
ABSTRACT
OBJECTIVE: To provide reference for the prevention of authority dissimilation of drug registration.METHODS: The economic model concerning drug registration was constructed with principal-agent theory.RESULTS: The occurrence of authority dissimilation of drug registration could be cut down by reducing public monitoring costs,improving the rate of prosecution and increasing the costs for dealing with moral risks.CONCLUSION: The authority dissimilation could be effectively prevented by balancing authority for drug registration,improving transparency of drug registration and supervisory system.