With the implementation of the policy of targeted poverty alleviation, the impoverished people under the current standards by 2020 will all be lifted out of poverty. Nevertheless, the solution to the existing problem of impoverished people does not mean that there will be no more impoverished people after that. Basic medical insurance, critical illness insurance program and medical assistance are important guarantees to prevent the emergence of impoverished people. The establishment of a tripartite system of sharing medical expenses, which may still require additional reimbursement, is an important basis for ensuring that there is no more impoverished by diseases and back to poverty due to illness. In this paper, we consider the problem of sharing additional expenses of medical insurance, introduce the theory of supply chain and game theory, and transform the problem into a multi-party cost-sharing problem. Firstly, we have constructed a cost-sharing model, to simplify the calculation of the proportions of parties, assume in which the basic medical insurance covers all the additional expenses, and critical illness insurance program and medical assistance achieve the purpose of sharing the additional reimbursement expenses by assuming the basic reimbursement expenses of the former. Then, the contract-bargaining process is composed of two Nash bargaining models. The problem of conflict and cost sharing is resolved according to the result of tripartite consultation, and the optimal decision of final cost sharing ratio is obtained. Finally, through the mathematical analysis of above-mentioned results, the more additional costs are borne, the more the basic costs are borne by critical illness insurance program and medical assistance, and the validity and correctness of the model are proved by data simulation.
Key words
impoverished people /
medical insurance reimbursement ratio /
cost sharing model /
Nash bargaining /
optimization decision
{{custom_keyword}} /
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] 桂华.相对贫困与反贫困政策体系[J].人民论坛, 2019(7):60-61. Gui H. Relative poverty and anti-poverty policy system[J]. People's Tribune, 2019(7):60-61.
[2] 张秀艳,潘云.贫困理论与反贫困政策研究进展[J].经济问题, 2017(3):1-5. Zhang X Y, Pan Y. The summary of poverty theory and anti-poverty policy[J]. On Economic Problems, 2017(3):1-5.
[3] 李小云.冲破“贫困陷阱”:深度贫困地区的脱贫攻坚[J].人民论坛(学术前沿), 2018(14):6-13. Li X Y. Break through the “poverty trap”:Lift the seriously impoverished areas out of poverty[J]. Frontiers, 2018(14):6-13.
[4] 汪三贵,曾小溪.后2020贫困问题初探[J].河海大学学报(哲学社会科学版), 2018, 20(2):7-13. Wang S G, Zeng X X. A study of poverty after 2020[J]. Journal of Hohai University (Philosophy and Social Sciences), 2018, 20(2):7-13.
[5] 吴宗敏,吴宇.全球贫困治理的深化与中国的实践创新[J].江苏大学学报(社会科学版), 2019, 21(1):19-27. Wu Z M, Wu Y. The deepening of global poverty governance and its practical innovation in China[J]. Journal of Jiangsu University (Social Science Edition), 2019, 21(1):19-27.
[6] 王晓燕,袁新生.社会医疗保险费用分担问题研究[J].财会月刊, 2007(1):16-17.Wang X Y, Yan X S. Study on the cost sharing of social medical insurance[J]. Finance and Accounting Monthly, 2007(1):16-17.
[7] 周绿林,童雪君,钱小山.构建居民医保长效筹资机制的研究-以镇江市为例[J].中国卫生事业管理, 2013(1):26-28. Zhou L L, Tong X J, Qian X S. Research of establishment of sustainable financing mechanism of urban resident basic health insurance system:Based on Zhenjiang for instance[J]. Chinese Health Service Management, 2013(1):26-28.
[8] 胡宏伟,吴振华.健康、家庭与期望医疗保险筹资模式:农民期望保险分担比例决定因素研究[J].学习与实践, 2009(4):128-135.Hu H W, Wu Z H. The financing model of health, family and expected medical insurance:A study on the determinants of farmers'share of expected insurance[J]. Study and Practice, 2009(4):128-135.
[9] 廖宇航.海南省医疗机构补偿机制改革对需方的影响[J].中国医院管理, 2019, 39(2):37-39. Liao Y H. Effectiveness of compensation mechanism reform on demanders'perspective in Hainan province[J]. Chinese Hospital Management, 2019, 39(2):37-39.
[10] 王珺,刘智勇.美国医疗保险市场改革风险分担机制的设计及启示[J].卫生经济研究, 2016(2):27-30. Wang J, Liu Z Y. The design and enlightenment based on mechanism of risk sharing in America medical insurance market-reform[J]. Health Economics Research, 2016(2):27-30.
[11] 尚越,吕国营.“健康中国”战略下基本医疗保险责任分担机制研究[J].中国医疗保险, 2017(8):16-20. Shang Y, Lü G Y. The responsibility sharing mechanism of basic medical insurance in China under the healthy China strategy[J]. China Health Insurance, 2017(8):16-20.
[12] 刘晶晶,吴群红,康正,等.基于Promodel仿真的医保基金收支平衡预测分析:以黑龙江省为例[J].中国卫生经济, 2017, 37(6):37-39. Liu J J, Wu Q H, Kang Z, et al. Forecast and analysis of income and expenditure balance of medical insurance fund based on Promodel simulation:Taking Heilongjiang as an example[J]. Chinese Health Economics, 2017, 37(6):37-39.
[13] 郎杰燕,孙淑云.中国基本医疗保险经办机构治理研究[J].云南社会科学, 2019, 227(1):88-94. Lang J Y, Sun S Y. Research on the governance of basic medical insurance agencies in China[J]. Social Sciences in Yunan, 2019, 227(1):88-94.
[14] Nikolay A K, Alexander M T. Demand functions in dynamic games[J]. IFAC-Papers OnLine, 2018, 51(32):271-276.
[15] Hou X Y, Gao Y J. Centralized decisions for a two-stage supply chain with price-discount dependent demand[J]. Journal of Systems Science and Information, 2018, 6(3):249-259.
[16] Wang J. A Stackelberg differential game for defence and economy[J]. Optimization Letters, 2018, 12(2):375-386.
[17] Shen B, Shen Y L, Ji W. Profit optimization in service-oriented data market:A Stackelberg game approach[J]. Future Generation Computer Systems, 2019, 95:17-25.
[18] Panda S, Modak N M, Basu M, et al. Channel coordination and profit distribution in a social responsible three-layer supply chain[J]. International Journal of Production Economics, 2015, 168:224-233.
{{custom_fnGroup.title_en}}
Footnotes
{{custom_fn.content}}
Funding
National Natural Science Foundation of China (71571090); the Youth Innovation Team of Shannxi Universities; the Fundamental Research Funds for the Central Universities (JB190601); Seed Foundation of Innovation Practice for Graduate Students in Xidian University
{{custom_fund}}
PDF(975 KB)
