Game theoretical analysis of hospital expense claiming strategy under global budgeting policy Reporter ： Juin-Yang Wang Advisor ： Cheng-Han Wu Date ： January

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory Content Introduction Literature Review The Model Anticipated Contribution 2

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory Motivation  Over budget is not always the best response strategy  The behavior of each hospital will be under the influence of other hospitals 3 Dilemma Therefore, the claim decision of hospital is important.

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory Motivation 4 Concern Global budget and deduction system Claim strategy and points Decision behavior Competition characteristics Interactive scenerios

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory Background Deduction System Global Budget System National Health Insurance Expenditure cap Game theory what condition ? best response strategy 5 Global Budget and Deduction System Get points by the deduction Points multiply point- value Overall claim points Under global budget Over global budget Chi （ 2005 ） Global budget No trust mechanism Grow up Dilemma Hung （ 2010 ） Fee for service Discount No decreasing the growth of expenses

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory  Develop medel  Consider other medical organization, derive best response strategy  Consider other medical organization, derive equilibrium strategy  Find out the condition of choosing over budget strategy  Provide insights 6 Objectives

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory 7 Literature Review 1. the hospital produces the behavior of competition in claim points, 2. the hospital doesn't have the motive of cooperation Hsu et al. （ 2007a ） Static equilibrium analysis

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory 8 1. Low service quantities may become the sub-game perfect Nash equilibrium under infinite repeated game 2. Improper design of GB system, moral hazard and risk Hsu et al. （ 2007b ） Game theoretical model Literature Review

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory Doctors will collaborate with each other for more profits 9 Fan, Chen and Kan （ 1998 ） Empirical economic method Literature Review Medical quality and medical service quantity will drease Mougeot and Naegelen （ 2005 ） Welfare economics theorem

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory 1. Treadmill effect 2. The effect serve quantity and point-value is anti-toward 10 Benstetter and Wambach （ 2006 ） develop expenditure price system Literature Review 1. Doctor will strengthen of treatment 2. Admission quantity increase 3. Decrease of point-value 4. Prisoner's dilemma Cheng et al. （ 2009 ） Generalized estimating equation

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory 11 Develop model decision claim strategy best response function optimal solution Nash equilibrium The model

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory The model 1. Introduction 12 Global Budget System Deduction System Development the model

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory The model-deduction process The hospitals who choose under- budget strategy The two heterogeneous hospitals Deduction Two hospitals of no over budget Over budget No deduction The hospitals who choose over-budget strategy Growing deduction Common deduction value of point reveal 13

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory The model - notation Decision Variable Parameter 14

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory The model - notation Global budget overall claimn amount claim upper limit of the tolerate 15

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory d.v.the growing and under take amount the common and under take amount No over-budget Over-budget can tolerate the excess amount of claim 16 The model - notation Surplus of i hospital

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory health market Best response strategy 17 hospital 1 Hospital i chooses under-budget strategy 2 Hospital j chooses over-budget strategy The model Best response strategy

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory The model hospital 18 Scenario 1 Hospital j chooses under-budget strategy under-budgetover-budget let Best response strategy

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory 19 when so The model Scenario 1 Hospital j chooses under-budget strategy Best response strategy, exist

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory 20 Scenario 2 The model hospital over-budgetunder-budget let Hospital j chooses over-budget strategy Best response strategy

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory 21, solvelet when so if The model Best response strategy

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory 22 Take for example The model Best response strategy

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory 23 Scenario 2 let when so if The model Best response strategy Hospital j chooses over-budget strategy

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory 24 The model Best response strategy Take for example

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory 25 let when so if The model Best response strategy, solve

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory 26 The model Best response strategy

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory 27 let when so if The model Best response strategy, solve

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory 28 Scenario 1 Scenario 2 if The model Best response strategy summary Hospital j chooses over-budget strategy Hospital j chooses under-budget strategy exist if

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory 29 hospital 2 hospital 1 over-budget hospital 2 hospital 1 one hospital The model over-budget Equilibrium strategy

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory 30 hospital 2 hospital 1 Strategic game The model Equilibrium strategy

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory 31 object function of hospital 1 object function of hospital 2 The model Equilibrium strategy

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory 32 solution The model Equilibrium strategy

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory 33 solution The model Equilibrium strategy

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory 34 Solution The model Equilibrium strategy

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory 35 The model Equilibrium strategy

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory 36 The model Equilibrium strategy

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory 37 Anticipated Contribution  We attained the equilibrium strategy  The factor influence claim behavior by empirical and parameter analysis  Discuss the current allocation of medical resources  Whether the hospitals be has speculate at behavior for more profit

National Yunlin University of Science & Technology Department of Industrial Engineering and Management Supply Chain Management Laboratory 38 The model – Expectation result reseach schedule work item 2012 年 2013 年 Literature Review and confirm topic Develop the model identification of model rationality Best response and equilibrium strategy Empirical and parametric analysis Conclusion and insight Future research

39