The Mechanism Design of Incentive Compatible Health Insurance System (III)

[[abstract]]健康保險市場中，由於保險人、被保險人、醫療提供者、以及政府或監理機構等交易主體彼此之間的資訊不對稱以及複雜的代理關係，因此容易產生道德風險以及風險選擇等市場失靈的現象。解決此市場失靈可由健保供需兩方之誘因機制著手。相較於需求面之部分負擔等誘因機制，供給面之誘因與市場競爭機制雖較具成本控制效果，但卻容易引發保險人或醫療提供者挑選健康者排拒不良風險的刮脂效應。健保各種支付制度的設計，即在於同時達到控制健保浪費與避免刮脂效應的目的。支付制度依其設計型式為回溯性或預付性給付，將對醫療提供者的行為策略、消費者的效用水準、以及均衡時之最適健保供需產生不同之影響。本研究計畫之目的乃以賽局理論的應用作為分析基礎，探討資訊對稱與不對稱下消費者的最適健保選擇，以及各種支付制度的組合對於醫療提供者行為決策之影響，並分析均衡時誘因相容之最適健保契約及其機制設計對於維持醫療品質與控制成本的效果。[[abstract]]The asymmetric information problems and the complicated principal-agent relationship between transaction entities, including the insurer, the insured, the health care provider and the government, in health insurance markets lead to market failure, such as moral hazard and risk selection. These market failures can be alleviated in two ways: the demand-side approach and the supply-side incentive combined with the mechanisms derived by market competition. Although arrangements consist of supply-side cost-sharing and market competition perform better function in cost containment, these arrangements have defeats in that the insurer or the provider may pick up good risks and discriminate bad risks, the so-called "cream-screaming" or "cherry-picking". The objectives of various kinds of payment system design are to control moral hazard and to avoid cream-screaming at the same time. Payment systems, either designed as retrospective or prospective, can have tremendous effects on the strategies of providers, the utilities of consumers and the optimal quantities in the equilibrium. By the application of game theory, the objectives of this research are to find the optimal health insurance of consumers under information symmetry and asymmetry and to discuss the impact of various combinations of payment systems on provider's strategies. In addition, this research derives the incentive compatible mechanisms that support health care quality and cost containment at the same time.[[note]]NSC91-2416-H327-02