医疗转诊建模评估及医保政策应用分析  

Healthcare Referral Performances Evaluation and Application on Medical Insurance Policies

作　　者：徐扬斌 李娜[1] XU Yang-bin;LI Na(School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, Chin)

机构地区：[1]上海交通大学机械与动力工程学院

出　　处：《工业工程与管理》2018年第2期167-172,179,共7页Industrial Engineering and Management

基　　金：国家自然科学基金资助项目(71471114,71432006)

摘　　要：基于马尔可夫理论对同一医联体内部上层医院和下层医院之间合作转诊的问题进行了排队网络的建模分析和优化决策。首先利用平均场理论对系统进行了分析，而后进一步设计了以矩阵几何为基础，以相关性迭代为算法，从而获得了系统的各类性能指标的解析结果。根据数值实验探讨了上层医院向下层医院的转诊率对系统性能的影响，并进一步指出该模型对保险共付比政策优化的潜在应用。该模型对于评估我国双向转诊系统的性能和相应的政策研究具有指导意义。The dual referral system was modeled and suggested optimal decisions were proposed between high-level hospitals and low-level hospitals based on Markov chain. Primarily, the system in mean-field theory was analyzed and then Matrix Geometric method and some related iteration methods were used to achieve the performance indicators. Through numerical experiments, the influence of transition rate from high-level hospital to low-level hospital to the performance indicators of the system was obtained. Further more, the potential applications of medical co-payment ratio in this system was discussed. The model will be used to evaluate the dual referral system and to make some related policies in future.

关 键 词：医疗双向转诊 排队论 平均场理论 矩阵几何 医保共付比 

分 类 号：F224.34[经济管理—国民经济]