“守门人”医疗系统中的转诊协调机制  

Referral coordination mechanism of gatekeeper healthcare system

作　　者：张悦 高照 李娜[1] ZHANG Yue;GAO Zhao;LI Na(School of Mechanical Engineering,Shanghai Jiao Tong University,Shanghai 200240,China)

机构地区：[1]上海交通大学机械与动力工程学院,上海200240

出　　处：《浙江大学学报（工学版）》2020年第12期2445-2456,共12页Journal of Zhejiang University：Engineering Science

基　　金：国家自然科学基金资助项目(71871138,71432006)。

摘　　要：为了探究"守门人"医疗系统的协调问题,建立系统内综合医院与社区医院间的转诊博弈模型,分别对非竞争型和竞争型的2种系统建模.模型分别研究系统集中决策下的最优转诊阈值策略以及服务支付契约合作模式下的最优契约形式.结论表明,降低系统内单位人员服务成本能够有效提升系统效用,引入竞争可以降低转诊率、促进社区医院首诊;非竞争与竞争型系统在不同规模下的服务支付契约对于实现系统协调均具有可行性,竞争系统下小规模设置的协调效率高于大规模设置的.在医疗系统设计中若无法避免竞争的存在,设置多个小型竞争医院能带来更高的社会效率.A referral model with general hospitals(GH)and community health centers(CHC)was established to analyze the coordination problem of the gatekeeper healthcare system.The non-competitive and competitive models respectively studied the optimal referral strategies and the optimal contract forms from centralized decision-making and service payment contract cooperation,and provided the conditions for system coordination.Results show that reducing the unit service costs in the system can effectively improve the system,and competition can increase the referral threshold to promote community first diagnosis.The non-competitive and competitive systems for service payment contract coordination at different scales are feasible.The coordination efficiency of small-scale is better than that of large-scale in competitive system,then designing multiple small competitive hospitals can bring higher social efficiency.

关 键 词：“守门人”系统 医疗系统 转诊博弈 协调机制 竞争 

分 类 号：F202[经济管理—国民经济]