我国医疗系统薪酬结构的博弈分析与制度设计

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摘要

我国目前有数量巨大的公立医疗单位，但从计划经济转向市场经济以来，我

国政府还没有一套比较规范完善，适用于医疗系统的薪酬体系，相当数量的医院

单位仍被旧的分配机制所约束。随着时代的发展，旧有的、国家统一的级别工资

制己经不适用了。作为与生命直接相关的职业，我国医疗系统单位的员工面对的

风险和责任都高于其他职业，其体力和脑力经常要处于高度紧张状态，且医疗单

位技术人才的名气和业务影响到整个单位的经济效益，人才市场的稀缺性又决定

了他们有较高的价值，但他们并没有得到更多的薪酬回报，付出与回报明显不合

理。由于薪酬设计的不合理性，导致高级人才的外流和灰色收入的形成。要改变

这种现状，可以借鉴国外的成功案例，结合我国基本国情，进行医疗体系薪酬制

度改革，配制合理的薪金水平及适用的薪酬设计，使我国医疗系统在市场的竞争

中健康、有序发展。

近年来，作为数学与经济学重要分支的博弈论，用来研究参与人之间的相互

作用，相互影响以寻找最优策略，已广泛的运用于各种薪酬制度研究中。本文回

顾改革开放以来历次薪酬分配制度改革，力图运用博弈理论进行分析，把政府、

医院、患者、医生作为博弈参与人，分析他们的行动之间相互影响相互制约关系，

再从政府的角度出发，找出一个符合目前中国国情、有助于国有医院发展的薪酬

分配制度办法，为政府今后进一步完善医疗系统资源薪酬管理提供参考依据。

本文的主要工作和研究成果如下：

1、对我国医疗系统薪酬现状进行研究，分析了医疗系统薪酬较低与医生灰色

收入之间的联系。

2、建立医生与患者的博弈模型，分析了优良薪酬制度下和不良薪酬制度下博

弈参与人的最优策略，验证了优良薪酬制度下医生的职业道德有所提高；建立医

生与政府的博弈模型，分析了政府的决策与医生的决策相互影响关系，探索了政

府该如何调节参数，提高医生职业道德。建立医生和医院的博弈模型以及效率工

资模型，分析了医院监管强度对医生决策的制约关系。建立政府、医院、医生的

三方博弈模型，在混合战略下探讨了政府与医院方如何行动以控制医生收红包行

为。基于以上分析，给出了政府适当调整医生薪酬的建议与方法。

3、建立政府、医院、患者、医生的四方动态博弈模型，详细分析了博弈参与

者行为的相互影响关系，求出博弈结束后各方的收益，进一步分析了政府调整医

生薪酬的意义和方法。

国内外对于博弈论以及医疗系统薪酬的研究分别有很多。本文尝试结合两者

进行研究，把调整医生薪酬问题放在静态及动态的博弈模型中去分析，从政府的

角度出发，以求得博弈参与者的最优策略。希望能起到抛砖引玉的作用，对我国

医疗系统薪酬改革的实行有所裨益。

关键词：医疗系统薪酬博弈论收益

ABSTRACT

During the 21st century, there are a great number of public health care units in our

country. Although our country has transferred to market economy from planned

economy, we have not applied a normative and comprehensive compensation

mechanism suitable to the health care system. Many health care units are still restricted

by old compensation mechanism. With the development of times, the old and nationally

unified level-based wage system has been outdated. In a career directly related to life

and death, the risks and responsibilities faced by health care professionals are higher

than those of other occupations. Health care professionals are always in high pressure

both physically and mentally. Although the reputation and the practice of talented health

care professionals promote the profits of their units and the scarcity of talented

professional determines their high value, these talented professionals do not receive

higher rewards and their compensations are obviously inconsistent with their value.

Unreasonable compensation system has lead to leaving of talented health care

professionals and existence of gray income. In order to change the status quo, we can

learn from success stories abroad and reform the compensation mechanism of health

care system according to our country’s basic national conditions. We can adopt

reasonable salary levels with suitable salary system design which can make our medical

system develop healthily and orderly in market competition of our country.

Game theory, as important branches of mathematics and economics used to

research the interaction and influence between participants to find the best strategies,

has been widely used in studies of various salary systems in recent years. The paper

reviews all the previous reforms of compensation mechanism since the beginning of

reform and opening-up, and tries to use game theory to analyze it. It considers the

government, hospitals, patients, doctors as participants of game and analyzes the

interaction and influence between them. From the perspective of the government, we

attempt to find a compensation system which accords with the situation of our county

and is helpful to the development of state-owned hospitals in order to provide reference

for the gove rnmen t to improve hea lth care system ’s salary management.

The main work and results of this work are as follows:

1、This thesis researches the status quo of health care system and analyzing the

relation between low salary and doctor’s gray income.

2、This thesis builds the game model between doctors and patients and analyzing

the optimal strategies of game participants under good and bad allocation mechanism,

respectively. This thesis found that the professional ethics of doctors will be promoted

under a good salary system. This thesis builds the game model of doctors and

government, analyzes the relationships between government decision-making and

doctor decision-making, and tries to find how to adjust the model parameters to improve

the professional ethics of doctors. This thesis builds the game model between doctors

and hospitals as well as the efficiency wage model to analyze the relationship between

regulatory intensity of hospitals and decision-making of doctors. Furthermore, it builds

the 3-party game model of government, hospitals and doctors and studies how the

government and hospitals can reduce the behavior of doctors receiving red envelopes

under the mixed strategy. Based on the above analysis, we strongly suggest that the

government shou ld adjust doctors pay app ropr iately as soon as poss ible .

3、This thesis builds dynamic game model involving government, hospitals,

patients and doctors. Then it analyzes the correlation in detail between the behaviors of

the game participants, deduces the earnings of all participants after the game, and

discusses the meaning and approaches of government adjusting doctors’ salaries.

There are much research about game theory and allocation mechanism of health

care system both at home and abroad. This paper attempts to combine the two to study

the pay adjustment problems in the dynamic game model. From the perspective of

government, the study indicates that we can achieve the optimal strategies for the game

players. We hope that this study can attract more attention on this kind of research topic

and be beneficial to the health care compensation system reform of our country.

Key Words: Health Care System，Compensation，Game Theory，Earnings

中文摘要

ABSTRACT

第一章绪论 ...................................................................................................................1

§1.1 研究背景 ...........................................................................................................1

§1.1.1 问题提出 ....................................................................................................1

§1.1.2 研究意义 ....................................................................................................2

§1.1.3 研究现状 .....................................................................................................2

§1.2 本文的结构 .......................................................................................................4

第二章相关研究综述与理论基础 .................................................................................5

§2.1 我国医疗体系薪酬现状 ...................................................................................5

§2.1.1 我国公立医医院现行薪酬体系 .................................................................5

§2.1.2 我国公立医院薪酬制度特点 .....................................................................8

§2.1.3 我国公立医院薪酬制度引发的负面影响 .................................................9

§2.2 博弈论 .............................................................................................................10

§2.2.1 博弈论的起源与发展 ................................................................................10

§2.2.2 博弈论的一般理论本质与基本概念 ........................................................11

§2.2.3 博弈的分类 ................................................................................................12

§2.2.3.1 完全信息静态博弈 .............................................................................12

§2.2.3.2 完全信息动态博弈 .............................................................................14

§2.3 本章小结 .........................................................................................................14

第三章基于提高医生薪酬下的两方博弈分析 ...........................................................15

§3.1 医生与患者的完全信息静态博弈模型 .........................................................15

§3.1.1 优良医疗系统薪酬制度下医生与患者的完全信息静态博弈模型 .......15

§3.1.1.1 模型假定与参数设定 ........................................................................15

§3.1.1.2 模型分析 ............................................................................................16

§3.1.1.3 小结 ...................................................................................................17

§3.1.2 不完善医疗系统薪酬制度下医生与患者的完全信息静态博弈模型 ...17

§3.1.2.1 模型假定与参数设定 ........................................................................18

§3.1.2.2 模型假定与参数设定 ........................................................................18

§3.1.2.3 小结 ....................................................................................................19

§3.2 医生与政府的完全信息动态两方博弈矩阵 .................................................19

§3.2.1 模型假定与参数设定 ................................................................................19

§3.2.2 模型分析 ....................................................................................................21

§3.2.3 小结 ...........................................................................................................22

§3.3 医生与医院博弈模型 .....................................................................................22

§3.3.1 医生与医院完全信息静态博弈模型分析 ...............................................23

§3.3.1.1 模型假定与参数设定 .......................................................................23

§3.3.1.2 模型分析 .............................................................................................23

§3.3.1.3 小结 ....................................................................................................24

§3.3.2 医生与医院的效益工资模型分析 ...........................................................24

§3.3.2.1 模型假定与参数设定 .......................................................................25

§3.3.2.2 模型分析 .............................................................................................25

§3.3.2.3 小结 ....................................................................................................27

第四章基于提高医生薪酬的三方静态博弈模型分析 .............................................29

§4.1 三方博弈模型建立 ..........................................................................................29

§4.2 模型假设与参数设定 ......................................................................................29

§4.3 模型求解与分析 ..............................................................................................31

§4.4 本章小结 .........................................................................................................33

第五章基于提高医生薪酬的四方动态博弈模型分析与制度设计 .........................35

§5.1 模型假设与参数设定 ......................................................................................35

§5.2 模型分析 ..........................................................................................................37

§5.2.1 各路经下收益表 .......................................................................................38

§5.2.2 收益表分析 ................................................................................................42

§5.3 模拟案例分析 .................................................................................................43

§5.4 医疗系统医生薪酬制度设计 ...........................................................................46

§5.5 本章小结 .........................................................................................................46

第六章总结及展望 .......................................................................................................47

§6.1 总结 .................................................................................................................47

§6.2 展望 .................................................................................................................48

参考文献 .........................................................................................................................49

在读期间公开发表的论文和承担科研项目及取得成果 .............................................53

致谢 ...............................................................................................................................55

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摘要：

摘要我国目前有数量巨大的公立医疗单位，但从计划经济转向市场经济以来，我国政府还没有一套比较规范完善，适用于医疗系统的薪酬体系，相当数量的医院单位仍被旧的分配机制所约束。随着时代的发展，旧有的、国家统一的级别工资制己经不适用了。作为与生命直接相关的职业，我国医疗系统单位的员工面对的风险和责任都高于其他职业，其体力和脑力经常要处于高度紧张状态，且医疗单位技术人才的名气和业务影响到整个单位的经济效益，人才市场的稀缺性又决定了他们有较高的价值，但他们并没有得到更多的薪酬回报，付出与回报明显不合理。由于薪酬设计的不合理性，导致高级人才的外流和灰色收入的形成。要改变这种现状，可以借鉴国外的成功案例，结合我...

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