Analysis of Incentive-Compatible Mechanism for Value-Based Healthcare under DRG/DIP Prepayment System
Chu Hongjie
Hou Zhiyuan
Abstract：Objective:To analyze the principal-agent dilemma under Diagnosis Related Groups/Diagnosis-Intervention Packet(DRG/DIP),propose an incentive-compatible mechanism and nudge design guided by value-based healthcare.Methods:Based on principal-agent theory,a doctor behavior model is constructed.By integrating incentive compatibility and nudge theory,a multi-party governance mechanism is proposed,which includes clinical decision support,performance evaluation,medical insurance payment adjustments,and social supervision.The doctor behaviors are analyzed under four scenarios:simple cost control,decision reminders,regulatory evaluation,and information disclosure.Results:Simple cost control cannot ensure service quality.The decision reminder mechanism reduces the cost of high-value services.The regulatory evaluation mechanism optimizes the benefit structure through economic incentives.The information disclosure system forms an implicit reputation constraint.Through multi-party governance,a positive cycle of"medical service quality,patient volume,revenue"is achieved,suppressing malpractice.Conclusion:The DRG/DIP prepaid system needs to balance cost control and value goals through an incentive-compatible mechanism.By integrating pre-event reminders,mid-event interventions,and post-event evaluations,a full-cycle strategy is proposed to promote medical insurance payment reform guided by value-based healthcare.
Keywords：Disease Related GroupDiagnosis-Intervention Packetprepayment systemvalue-based healthcareincentive compatibilityprincipal-agent theorynudge theory
Publication Date：2026-02-05
Online Publishing Date：2026-03-16(First online date of this platform, not the publication date of the document)
Pages：4( 9-12 )