|
|
Toward Building a Hierarchical Medical System for Major Infectious Diseases in China: Based on an Incomplete Information Mechanism Design |
Jiang Yuexiang1, Guo Junfei1, Sun Rui2 |
1.School of Economics, Zhejiang University, Hangzhou 310058, China 2.Haas School of Business, University of California, Berkeley, CA 94704, USA |
|
|
Abstract The COVID-19 epidemic continues to pose a big challenge to the allocation of medical resources. During the epidemic, it has been challenging to maximize the utility of medical resources and the efficiency of medical service systems by applying hierarchical and diversion functions. This study works from the perspective of micro-game theory, to build a principal-agent model of the medical system for major infectious diseases. Patients’ degree-of-illness, signal impulse feedback, probability of cure, and medical services transfer are included into the model, which has proved that a hierarchical model is the right choice for the maximum utility of the medical system. The model has also verified the effectiveness, scientific basis, and correctness of the hierarchical medical system.Based on theoretical conditions of complete information, the optimal mechanism of resource allocation in the medical service system is deduced under the benchmark model by using the principal-agent model. It is concluded that a hierarchical model is a scientifically systematic one that will maximize the utility of the medical system in response to the COVID-19 epidemic. In the principal-agent model, the patients’ signal impulse feedback is regarded as the critical setting of the hierarchical medical system. Although the model proposed works under the condition of complete information, and is thus not a reflection of the actual situation, it provides an optimal mechanism and results for maximizing the utility of the medical service system under the theoretical condition of complete information. It can usefully set the optimal benchmark for the real environment under conditions of incomplete information.The medical system cannot observe whether the patients’ signal impulse feedback of the hierarchical medical system is true at first. Therefore, in the case of the same information disclosure and decision-making rules, we prove that the results are consistent with the benchmark model when considering the sequential incentive compatibility of the two-stage direct mechanism. Based on the realistic condition of incomplete information, the hierarchical medical system can still ensure that patients with different degrees of illness receive corresponding optimal medical services while avoiding “medical runs” when controlling a certain cure rate and effective medical service incentive compatibility constraints. The transfer payment function in the principal-agent model can be administrative punishment, medical expenses, etc. In reality, the hierarchical medical system of the COVID-19 epidemic has a certain administrative compulsion. Due to the fact that administrative implementation may lead to the waste of political resources and abuse of administrative power, this paper introduces the medical service transfer dimension of the hierarchical medical system to ensure the sensible incentive compatibility of the mechanism under the assumption of incomplete information. Even in the case of non-administrative intervention, the hierarchical medical system is still the optimal choice for the medical system, which is the “invisible hand” of the market, promoting the maximum utility of medical resources allocation.Implementing a hierarchical medical system to prevent and control COVID-19 has effectively alleviated the pressure of “medical runs” and the spread of infection. The implementation highlights the significance of promoting the construction of the hierarchical medical system in the current medical reform. The implementation also proposes an effective mechanism design for preventing and controlling major infectious diseases. Based on this model, we put forward policy-related suggestions on the construction of a hierarchical medical system for major infectious diseases, the improvement of the administrative work transition, and the refinement of an incentive and restraint mechanism of the transfer payment such as medical services. These suggestions help to ensure the long-term operation of the hierarchical medical system for the prevention and control of major infectious diseases.
|
Received: 30 March 2021
|
|
|
|
|
1 习近平: 《在统筹推进新冠肺炎疫情防控和经济社会发展工作部署会议上的讲话》,2020年2月23日,http://cpc.people.com.cn/n1/2020/0223/c64094-31600380.html,2021年3月30日。2 习近平: 《全面提高依法防控依法治理能力 健全国家公共卫生应急管理体系》,《求是》2020年第5期,第4-8页。3 金碚: 《论经济的组织资本与组织政策——兼议新冠肺炎疫情的启示》,《中国工业经济》2020年第4期,第23-41页。4 李玲: 《分级诊疗的基本理论及国际经验》,《卫生经济研究》2018年第1期,第7-9页。5 余红星、冯友梅、付旻等: 《医疗机构分工协作的国际经验及启示——基于英国、德国、新加坡和美国的分析》,《中国卫生政策研究》2014年第6期,第10-15页。6 代涛、陈瑶、韦潇: 《医疗卫生服务体系整合:国际视角与中国实践》,《中国卫生政策研究》2012年第9期,第1-9页。7 高和荣: 《健康治理与中国分级诊疗制度》,《公共管理学报》2017年第2期,第139-144,159页。8 张录法: 《后疫情时代城市分级诊疗体系:改革方向与治理策略》,《南京社会科学》2020年第4期,第7-13页。9 申曙光、张勃: 《分级诊疗、基层首诊与基层医疗卫生机构建设》,《学海》2016第2期,第48-57页。10 张茅: 《县域医疗卫生改革发展的探索与实践》,《管理世界》2011年第2期,第 1-4,48页。11 姚泽麟: 《政府职能与分级诊疗——“制度嵌入性”视角的历史总结》,《公共管理学报》2016第3期,第61-70,155-156页。12 张维迎: 《博奕论与信息经济学》,上海:上海人民出版社,1996年。13 Ross S., “The economic theory of agency: the principal’s problem,” American Economic Review, Vol. 63, No. 2 (1973), pp. 134-139.14 Spence M. & Zeckhauser R., “Insurance, information and individual action,” American Economic Review, Vol. 61, No. 2 (1971), pp. 380-387.15 Milgrom P. & Weber R., “A theory of auctions and competitive bidding,” Econometrica, Vol. 50, No. 5 (1982), pp. 1089-1122.16 Ottaviani M. & Prat. A., “The value of public information in monopoly,” Econometrica, Vol. 69, No. 6 (2001), pp. 1673-1683.17 Persico N., “Information acquisition in auctions,” Econometrica, Vol. 68, No. 1 (2000), pp. 135-148.18 Lewis T. & Sappington D., “Supplying information to facilitate price discrimination,” International Economic Review, Vol. 35, No. 2 (1994), pp. 309-327.19 Bergemann D. & Pesendorfer M., “Information structures in optimal auctions,” Journal of Economic Theory, Vol. 137, No. 2 (2007), pp. 580-609.20 马本江: 《基于委托代理理论的医患交易契约设计》,《经济研究》2007年第12期,第72-81页。21 谢子远、鞠芳辉、郑长娟: 《“第三方购买”:医疗服务市场化改革的路径选择及其经济学分析》,《中国工业经济》2005年第11期,第51-58页。22 Mirrlees J.A., “An exploration in the theory of optimum income taxation,” The Review of Economic Studies, Vol. 38, No. 2 (1971), pp. 175-208.23 Fudenberg D. & Tirole J., Game Theory, Cambridge, MA.: MIT Press, 1991.24 Royden H. L., Real Analysis, New York: Macmillen Publishing Company, 1988.25 Riordan M. H. & Sappington D. E. M., “Awarding monopoly franchises,” American Economic Review, Vol. 77, No. 3 (1987), pp. 375-387.
|
|
1 习近平: 《在统筹推进新冠肺炎疫情防控和经济社会发展工作部署会议上的讲话》,2020年2月23日,http://cpc.people.com.cn/n1/2020/0223/c64094-31600380.html,2021年3月30日。2 习近平: 《全面提高依法防控依法治理能力 健全国家公共卫生应急管理体系》,《求是》2020年第5期,第4-8页。3 金碚: 《论经济的组织资本与组织政策——兼议新冠肺炎疫情的启示》,《中国工业经济》2020年第4期,第23-41页。4 李玲: 《分级诊疗的基本理论及国际经验》,《卫生经济研究》2018年第1期,第7-9页。5 余红星、冯友梅、付旻等: 《医疗机构分工协作的国际经验及启示——基于英国、德国、新加坡和美国的分析》,《中国卫生政策研究》2014年第6期,第10-15页。6 代涛、陈瑶、韦潇: 《医疗卫生服务体系整合:国际视角与中国实践》,《中国卫生政策研究》2012年第9期,第1-9页。7 高和荣: 《健康治理与中国分级诊疗制度》,《公共管理学报》2017年第2期,第139-144,159页。8 张录法: 《后疫情时代城市分级诊疗体系:改革方向与治理策略》,《南京社会科学》2020年第4期,第7-13页。9 申曙光、张勃: 《分级诊疗、基层首诊与基层医疗卫生机构建设》,《学海》2016第2期,第48-57页。10 张茅: 《县域医疗卫生改革发展的探索与实践》,《管理世界》2011年第2期,第 1-4,48页。11 姚泽麟: 《政府职能与分级诊疗——“制度嵌入性”视角的历史总结》,《公共管理学报》2016第3期,第61-70,155-156页。12 张维迎: 《博奕论与信息经济学》,上海:上海人民出版社,1996年。13 Ross S., “The economic theory of agency: the principal’s problem,” American Economic Review, Vol. 63, No. 2 (1973), pp. 134-139.14 Spence M. & Zeckhauser R., “Insurance, information and individual action,” American Economic Review, Vol. 61, No. 2 (1971), pp. 380-387.15 Milgrom P. & Weber R., “A theory of auctions and competitive bidding,” Econometrica, Vol. 50, No. 5 (1982), pp. 1089-1122.16 Ottaviani M. & Prat. A., “The value of public information in monopoly,” Econometrica, Vol. 69, No. 6 (2001), pp. 1673-1683.17 Persico N., “Information acquisition in auctions,” Econometrica, Vol. 68, No. 1 (2000), pp. 135-148.18 Lewis T. & Sappington D., “Supplying information to facilitate price discrimination,” International Economic Review, Vol. 35, No. 2 (1994), pp. 309-327.19 Bergemann D. & Pesendorfer M., “Information structures in optimal auctions,” Journal of Economic Theory, Vol. 137, No. 2 (2007), pp. 580-609.20 马本江: 《基于委托代理理论的医患交易契约设计》,《经济研究》2007年第12期,第72-81页。21 谢子远、鞠芳辉、郑长娟: 《“第三方购买”:医疗服务市场化改革的路径选择及其经济学分析》,《中国工业经济》2005年第11期,第51-58页。22 Mirrlees J.A., “An exploration in the theory of optimum income taxation,” The Review of Economic Studies, Vol. 38, No. 2 (1971), pp. 175-208.23 Fudenberg D. & Tirole J., Game Theory, Cambridge, MA.: MIT Press, 1991.24 Royden H. L., Real Analysis, New York: Macmillen Publishing Company, 1988.25 Riordan M. H. & Sappington D. E. M., “Awarding monopoly franchises,” American Economic Review, Vol. 77, No. 3 (1987), pp. 375-387.
|
|
|
|