基于分级诊疗体系的转诊与政府投资决策研究

针对我国分级诊疗实施过程中,由于基层医疗机构服务能力不足所造成的“上转容易下转难”的困境,研究了政府部门对社区医院服务能力进行投资以促进病人下转的问题.通过构建四阶段的博弈模型,探讨了为实现医疗系统总病人效用最大化的政府资金均衡投入策略,为实现三甲医院期望效益最大化的病人下转策略,病人效用最大化下的社区医院服务能力规划以及基于期望效益最大化下的病人选择.研究发现：1)三甲医院的期望效益受到政府投资金额的影响,当政府投资金额不足时,三甲医院的期望效益仅能达到次优;2)三甲医院病人的均衡转诊率受到三甲医院的治疗价格和政府的资金投入量的影响;3)在实现整个医疗系统总病人效用最大化上,虽然总病人效用随政府投入金额的增加而增加,但从政府角度来讲,政府投资金额不宜过大.

Referral and Government Investment Decision-Making Study Based on Hierarchical Medical System

In view of the problem that downward referral is more difficult than upward referral caused by the lack of service capacity of primary medical institutions in the hierarchical healthcare systems in China, this paper studies the government investment in community hospital service capacity in order to promote patients'' referral. By establishing the four-stage queuing game, this paper studies the patients'' referral strategy to maximize the expected benefit of the high-level hospital, the planning of the community hospital service capacity to maximize the patient''s utility, the investment strategy of government funds to maximize the total patients'' utility and patient''s selection to maximize its expected utility. It shows that 1) The expected benefit of the high-level hospital is affected by the amount of government investment. When the amount of government investment is insufficient, the expected benefit of the high-level hospital can only reach the second-best; 2) The referral rate of patients in high-level hospitals is affected by the treatment price of the high-level hospitals and the amount of government funds; 3) In terms of the total patients'' utility maximization, although the total patients'' utility increases with the increase of government investment, from the perspective of the government, the amount of government investment should not be too large.