分级诊疗背景下三级医院重症患者康复期转诊的演化博弈分析  

Evolutionary game analysis of the referral of convalescent critically ill patients in tertiary hospitals in the context of hierarchical diagnosis and treatment

作　　者：姚心怡 温宗良 卢亚娟 Yao Xinyi;Wen Zongliang;Lu Yajuan(School of Management,Xuzhou Medical University,Xuzhou 221004,Jiangsu Province,China;Affiliated Hospital of Xuzhou Medical University)

机构地区：[1]徐州医科大学管理学院,徐州221004 [2]徐州医科大学附属医院

出　　处：《中国医疗管理科学》2023年第1期21-26,共6页Chinese Journal Of Medical Management Sciences

基　　金：国家社会科学基金项目(19BGL251);江苏省博士后科研资助计划资助项目(2021K629C);江苏省研究生科研与实践创新计划资助项目(KYCX21_2636)。

摘　　要：目的分析三级医院重症患者康复期,医保部门、医院、患者三方之间的利益关系,探讨政府不同协调策略下,医院和患者策略的演化路径及其影响因素。方法通过构建医保部门、医院和患者三方的演化博弈模型,利用Matlab软件进行仿真分析。结果医保部门积极补贴策略下,更易形成医患双方共赢的局面;消极补贴策略下,则易导致卫生总费用增加但患者难下转的恶性循环,进而导致患者对三级医院的信赖感下降。结论明确政府在推进分级诊疗中的协调主体地位;充分发挥医疗保险的经济杠杆作用;推进基层医疗卫生机构的设施建设和家庭医生签约服务;通过多种手段更好地宣传和落实分级诊疗措施。Objective To analyze the interest relationships among healthcare security authorities,hospitals,and patients during the recovery period of critically ill patients in tertiary hospitals and to explore the evolution path and influencing factors of hospital and patient strategies under different coordination strategies of the government authorities.Methods The evolutionary game model involving healthcare security authorities,hospitals and patients was established,and simulation analysis was performed using the Matlab software.Results An active subsidy strategy by healthcare security authorities helps form a win-win situation for both hospitals and patients;in contrast,a passive subsidy strategy may lead to a vicious circle,in which the total health cost increases,but patients are difficult to be transferred to lower-level hospitals,which in turn leads to a decline in patients’trust in tertiary hospitals.Conclusions Government authorities should play a central role in promoting hierarchical diagnosis and treatment.Medical insurance should be given a full play to economic leverage.The construction of facilities in grassroots medical institutions and the family doctor contracting services be promoted.Hierarchical diagnosis and treatment should be advocated and implemented through a variety of means.

关 键 词：三级医院 重症患者康复期 转诊 政府协调 分级诊疗制度 演化博弈 

分 类 号：R197[医药卫生—卫生事业管理]