| Project/Area Number |
10630062
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Field |
経済政策(含経済事情)
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| Research Institution | Yokkaichi University |
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Principal Investigator |
INAGAKI Hideo Yokkaichi Universityu, Economics, Professor, 経済学部, 教授 (70159937)
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| Co-Investigator(Kenkyū-buntansha) |
KAMATA Shigenori Meijo University, Urban Science, Associate Professor, 都市情報学部, 助教授 (70214509)
MORI Toru Nagoya City University, Economics, Professor, 経済学部, 教授 (60134160)
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| Project Period (FY) |
1998 – 1999
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| Project Status |
Completed (Fiscal Year 1999)
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| Budget Amount *help |
¥4,000,000 (Direct Cost: ¥4,000,000)
Fiscal Year 1999: ¥1,100,000 (Direct Cost: ¥1,100,000)
Fiscal Year 1998: ¥2,900,000 (Direct Cost: ¥2,900,000)
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| Keywords | payment system for reimbursement / fee-for-service payment system / prospective payment system / econometric method / experimental economics / supply of treatments / medical institution selection / computer network system / 医療報酬支払制度 / 医療経済実験 / 包括支払制度 / 出来高払制度 / 個別出来高払制 / 定額払制 / 診療報酬制度改革 / 医師 / 患者 |
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| Research Abstract |
The reform of payment system for reimbursement to medical institutions in U.K. and U.S. carries on in the direction where U.S. with fee-for-service payment system (FFS) introduced prospective payment system (PPS) and U.K. with PPS introduced FFS. The two countries efforts to search for a set combined adequately two kinds of these. If medical institution is motivated to maximize their profits, the theoretical verification about workings of the payment system has the result that PPS may causes the under-supply of treatments and FFS causes the over-supply.
Empirical studies about effect which the reimbursement was changed is verified by econometric method. But precise conclusions are not given by difficulty of medical data collection. We verify the theoretical result by the method of experimental economics that does not need existing data. In the experiment assuming the profit maximization in the medical institution, the over-supply was not caused. Statistical testing to our experimental d
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ata suggests that most of medical institution subject concerned more for patient subject's benefits than for their self-profits. Judging from the result of our experiments, we can expect that the introduction of PPS does not cause drastic fall in treatments.
Because the medical institution selection by patients was impossible in the theory model used by the above-mentioned experiment, we expanded it to a dynamic model, which patients can be free to select a medical institution. The main result is the following. Medical expenditures fell greatly just after switching from FFS to PPS. But it converges in almost the same as medical expenditures under FFS with progress of the selection.
This result is examined by the computer network system based on the method of experimental economics. This experiment demonstrates the validity of theoretical result. That is, when the treatment of the medical institution visited by patients and the average treatment were already known, the result to equalize the treatment under PPS by the patient's free selection based on the discrepancy between the two. Now, we are making an articles about this result. Less
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