分级诊疗服务系统中协调医疗转诊的政府补贴机制研究  

Government subsidy schemes for coordinating healthcare referral in hierarchical service systems

作　　者：李忠萍 LI Zhongping(School of Business,Anhui University,Hefei 230601,China)

机构地区：[1]安徽大学商学院,安徽合肥230601

出　　处：《管理工程学报》2023年第3期103-117,共15页Journal of Industrial Engineering and Engineering Management

基　　金：国家自然科学基金资助项目(72101001、71801001);国家教育部科学基金资助项目(21YJC630070)。

摘　　要：本文研究协调医疗转诊制度运作的政府补贴机制设计问题。通过构建分级诊疗服务系统中政府、三级医院、社区医院及患者之间的一个四阶段博弈理论排队模型,本文给出各方参与主体的均衡决策和均衡绩效;评估有限财政补贴预算情形下影响补贴社区医院与补贴下转患者两种协调机制引导患者自愿下转进而促使医疗服务运营效能与社会福利提升及等待时间降低效率的影响机理。研究发现:对较低、中高、高等的运营利润关切度,或较高的社区能力成本,或足够少的预算,补贴社区更有助于患者下转的运行、患者效益与社会福利的提高以及等待时间的降低;对于较中低的运营利润关切度,或足够低的社区能力成本,或较中等的预算,补贴下转患者反而更优;对于较中等的运营利润关切度与社区能力成本,而预算较多时,补贴社区医院尽管对患者下转率及其效益提高、等待时间降低更有效,但对社会福利的提升的效率反而更低。Along with the increasing trend of the aging population and the outstanding contradiction between supply and demand caused by the scarcity and serious uneven distribution of high-quality medical resources in China,the implementation of hierarchical healthcare to improve the overall operational efficiency of the healthcare services is the core strategy of the current healthcare system reform.To accelerate the implementation of the hierarchical healthcare system,the government healthcare reform departments in some provinces and cities in China have proposed to induce the downward transfer of patients by the schemes of subsidies.In this regard,the research on the government subsidy scheme for coordinating the healthcare referral system has recently become a difficult and hot issue for scholars in the field of healthcare service operations and management.However,most of the relevant studies focus on the two-tier service system composed of two service providers with different operational objectives and operational decisions and explore the subsidy coordination scheme of the government to the toll system or the customers of the toll system to divert the customers or patients of the free system.In contrast,in inducing patients in the Chinese hierarchical healthcare service system to refer to the community hospitals for receiving follow-up treatment so as to reduce the demand for care in the tertiary hospitals,the government not only needs to subsidize the tertiary hospitals but also provides subsidies for patients who willingly transfer to the community hospitals or for community hospitals which expand their service capacities.Thus,this paper examines two subsidy schemes for coordinating the healthcare referral system:subsidizing the tertiary hospital and community hospital(called the H+H scheme),subsidizing the tertiary hospitals and referral patients(called the H+P scheme)to promote the effective implementation of the referral system via encouraging“tertiary hospitals to eagerly release”and“patients to willingly

关 键 词：医疗转诊 补贴机制 社会福利 等待时间 博弈排队论 

分 类 号：F812[经济管理—财政学] R197[医药卫生—卫生事业管理]