健康长寿是人类追求的基本目标，有相关统计表明，疾病是影响人类寿命的主要因素之一，而疾病对于贫困人口的影响更加显著。由于医疗技术的提升、优质医疗资源分布不均以及医药成本上升等诸多现实因素的影响，人们面对疾病所需承担的医疗费用正在逐年上升，特别是一些慢性病和重大疾病。这对于长期处于贫困线附近或者贫困线以下的家庭而言无疑是巨大的压力。就目前贫困人口“因病致贫”的现状而言，绝大多数贫困人口因常年受到疾病的纠缠而只能滞留在贫困的境地。2020年我国要实现第一个百年目标即全面建成小康社会，在精准扶贫战略的大背景下，建立并有效运行标准化的、完备的医疗保障体系，优化处理其相关问题，这具有重要的理论意义和现实意义。鉴于此，本文以精准扶贫战略下贫困人口的医疗保障体系作为研究背景综合运用供应链优化决策、费用分担博弈、监管博弈等理论与方法，研究针对贫困人口特别是慢性病群体相关医疗保障体系优化决策问题。
       首先，通过构建新的医疗服务保障决策范式，将医疗服务下放到底层，不仅可以满足已患病人口对于医疗服务的需求，同时也可以做到对于其他未患病人群的医疗保障进而减少“因病返贫”的可能性。将供应链管理的思想引入到精准扶贫背景下贫困人口医疗保障优化决策问题，把贫困人口医疗保障问题转化为一个多层供应链优化决策问题。本文构建了一个含有机会约束的贫困人口医疗保障决策的非线性整数规划模型。通过借鉴经典的报童模型的原理，将含有机会约束的非线性整数规划模型，转化为一个只含有机会约束的线性整数规划模型。然后，详细讨论了构建库存模型的适应范围，使之可以更好的与医疗保障体制构建相结合。此外，将理论模型应用于实际数据，采用MATLAB的整数规划求解器给出了该实际问题的程序化的求解过程，并得出最优决策方案并给出相关管理建议。
      其次，考虑到2020年现行标准下的贫困人口将全部脱贫，但并不代表从此之后再不会出现“因病致贫”人群，而基本医保, 大病保险和医疗救助是防止出现贫困人口的重要保障。通过构建医疗费用的三方分担体系，分担一部分可能仍需要额外报销的费用。通过引入供应链和博弈论的思想, 将该问题转化为一个多方分担费用的问题，建立了一个费用分担模型。为了简化各方分担比例的计算，假设由基本医疗保险承担全部的额外报销费用，大病保险和医疗救助通过承担前者的基本报销费用达到分担额外报销费用的目的。使用两个纳什均衡的讨价还价模型组成整个协商过程。根据三方的协商结果解决各方冲突和费用分担问题, 并得到最终费用分担比例的优化决策。并通过对其分担结果进行数值分析得到随着承担的额外费用越多，大病保险和医疗救助承担的基本费用更多，并且通过数据模拟证明模型的有效性和正确性。
       最后，要使标准化的医疗保障模式以及合理的医疗费用分担决策对“因病致贫”的贫困人口现状改善真正起到应有的作用，需要有效的监管措施。特别是对基层医疗机构的服务态度、专业性程度以及对于基层医疗机构对于医保报销政策的正确实行进行监督。而当代社会除了相关部门的监管之外，不可忽视的是社会公众基于互联网多媒体平台形成的第三方舆论监督。本文在分析了基本的医疗机构和监管部门的博弈决策后，加入第三方监管，特别考虑第三方监管参与度以及其向外传递的信息的真实性，构建基于三方监管的演化博弈模型。通过分析得到，在第三方舆论监督的形成可能性越大且舆论本身真实性越高的情况下，舆论监督会对监管部门的监督作用起到替代作用；同时，第三方舆论监督的形成可能性越高，会促使基层医疗机构规范自己的行为。当第三方舆论监督的形成概率高但是其向外传递的信息多为刻意抹黑的虚假信息，会对监管产生负面的影响。这就需要政府部门对于第三方监管的真实性进行规范和管理，避免因虚假信息产生的不良后果。
 

~Healthy longevity is the basic goal of human pursuit. Relevant statistics show that disease is one of the main factors affecting human life, and the impact of disease on the poor population is more significant. Because of the improvement of medical technology, the uneven distribution of quality medical resources and the increase of medical cost, the medical expenses that people have to bear in the face of diseases are increasing year by year, especially some chronic diseases and major diseases. This is undoubtedly a great pressure on families who have long been near or below the poverty line. As far as the current situation of "poor people because of illness" is concerned, the vast majority of poor people can only stay in poverty for a long time because of the perennial entanglement of disease. It is of great theoretical and practical significance to establish and effectively run a standardized and complete medical security system under the background of precision poverty alleviation strategy and optimize the handling of its related problems. In view of this, this paper takes the medical security system of the poor population under the strategy of precision poverty alleviation as the research background to comprehensively use the supply chain optimization decision-making, cost sharing game, supervision game and other theories and methods to study the optimization decision-making of the medical security system for the poor population, especially the chronic disease group.

Next, the impoverished people under the current standards by 2020 will all be lifted out of poverty. However, this not mean that there will be no more impoverished people after that. Basic medical insurance, critical illness insurance program and medical assistance are important guarantees to prevent the emergence of impoverished people. This paper establishment of a tripartite system of sharing medical expenses, which may still require additional reimbursement. We consider the problem of sharing additional expenses of medical insurance, introduce the theory of supply chain and game theory, and transform the problem into a multi-party cost-sharing problem. We have constructed a cost-sharing model, to simplify the calculation of the proportions of parties, assume in which the basic medical insurance covers all the additional expenses, and critical illness insurance program and medical assistance achieve the purpose of sharing the additional reimbursement expenses by assuming the basic reimbursement expenses of the former. Then, the contract-bargaining process is composed of two Nash bargaining models. The problem of conflict and cost sharing is resolved according to the result of tripartite consultation, and the optimal decision of final cost sharing ratio is obtained. Finally, through the mathematical analysis of above-mentioned results, the more additional costs are borne, the more the basic costs are borne by critical illness insurance program and medical assistance, and the validity and correctness of the model are proved by data simulation.

Finally, in order to make the standardized medical security model and reasonable medical cost sharing decision really play its due role in improving the present situation of the poor population "caused by illness ", effective supervision measures are needed. In particular, the service attitude of primary medical institutions, the degree of professionalism and the primary medical institutions for the correct implementation of medical insurance reimbursement policy supervision. In addition to the supervision of relevant departments, the supervision of third-party public opinion formed by the public on the Internet multimedia platform can not be ignored. After analyzing the game decisions of basic medical institutions and regulators, this paper adds third-party supervision, especially considering the participation of third-party supervision and the authenticity of the information transmitted to the outside, and constructs an evolutionary game model based on tripartite supervision. Through the analysis, the more likely the formation of the third-party public opinion supervision and the higher the authenticity of the public opinion itself, the public opinion supervision will play a substitute role in the supervision of the supervision department; at the same time, the higher the formation possibility of the third-party public opinion supervision will urge the primary medical institutions to regulate their own behavior. When the formation probability of third-party public opinion supervision is high, but the information transmitted to the outside is mostly deliberately smear false information, it will have a negative impact on supervision. This requires government departments to regulate and manage the authenticity of third-party supervision to avoid the adverse consequences caused by false information.

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