基于分级诊疗体系的下转决策及支付机制研究

在分级诊疗体系下,运用M/M/1排队与博弈论,构建了从综合医院到社区医疗服务中心转诊的期望效益函数模型.获得了医院的均衡下转率及均衡效益,研究发现病人对综合医院越偏好,医院的均衡下转率越高;两阶段治疗划分标准的差异性越低,均衡转诊越低以及对医院越有利.给出一种支付策略,有效刺激了综合医院将病人下转,并实现了综合医院、社区医疗服务中心及整个医疗系统的共赢.通过数值实验探讨了支付费用对均衡下转率及均衡效益的影响,并比较了支付策略下、非支付策略下的均衡下转率与均衡效益等,进而给出一些管理启示,为转诊有效实施提供理论支撑及政策参考.

Downstream referral decisions and payments mechanism in a hierarchical healthcare system

We develop the expected utility function model of referring patients from a comprehensive hospital to a community healthcare centre using M/M/1 queueing and game theory in a hierarchical healthcare system. The equilibrium downstream referral rates and equilibrium utilities of hospitals are obtained. We find that the equilibrium downstream referral rates increase with the patients' preference for the comprehensive hospital. The lower the difference between partition criterion of two-stage treatment, the lower the equilibrium downstream referral rates, which benefits the hospital. When the motivation of the comprehensive hospital with patients referral is low, we can achieve all-win of the comprehensive hospital, the community healthcare centre and the whole healthcare system by a payment strategy. We use a numerical experiment to discuss the effect of payment on equilibrium downstream referral rates and equilibrium utilities, and compare the equilibrium downstream referral rates and equilibrium utilities in the payment strategy and the non-payment strategy cases, then give some management implications and provide some theoretical support and policy reference to promote effective implementation of referral.