分级诊疗下基于排队网络的医联体系统优化  

Medical Alliance System Optimization Based on Queuing Network under Hierarchical Diagnosis and Treatment

作　　者：肖丽萍 李加莲 邵雪焱 池宏 XIAO Li-ping;LI Jia-lian;SHAO Xue-yan;CHI Hong(Institutes of Science and Development,Chinese Academy of Sciences,Beijing 100190,China;School of Public Policy and Management,University of Chinese Academy of Sciences,Beijing 100049,China)

机构地区：[1]中国科学院科技战略咨询研究院,北京100190 [2]中国科学院大学公共政策与管理学院,北京100049

出　　处：《中国管理科学》2023年第9期186-195,共10页Chinese Journal of Management Science

基　　金：国家自然科学基金资助项目(72134004)。

摘　　要：在我国大力推进分级诊疗和医联体建设的过程中,如何优化医联体系统运行是需要解决的关键问题之一。本文将患者分为轻、重症两类,就医过程分为诊断、治疗、康复三个阶段,基于分级诊疗模式下医联体运行机理剖析和排队网络理论,分析轻、重症两类患者在医联体中的就医路径,建立了两优先级带堵塞排队网络模型,基于患者外部到达率和各节点服务率求解各节点的医疗资源利用率、平均排队人数以及平均等待时间等系统运行指标。在此基础上,分别建立针对短期(医疗资源无法增加且就医选择不变)和长期(基层医疗机构服务质量提高且就医选择改变)两种情形下的医联体系统优化模型,优化目标为患者等待、转诊成本和医院运营成本之和最小,决策变量为各级医疗机构医疗资源的配置。最后通过算例检验所建立优化模型的合理性,并探讨短期和长期两种情形下医联体系统优化的调整策略,为分级诊疗和医联体建设相关政策的制定提供理论方法支撑。With the improvement of people's living standards and the acceleration of aging process,people's demand for medical resources,especially high-quality medical resources,is growing more faster.However,high-quality medical resources are difficult to increase in the short term.The contradiction between supply and demand of medical resources has brought great difficulties to the implementation of hierarchical diagnosis and treatment policy.Therefore,to ensure the implementation effect of relevant policies,the optimal allocation of medical resources of medical institutions at all levels in the medical alliance under the hierarchical diagnosis and treatment mode,has become an urgent problem to be solved.The patients are divided into mild and severe groups,and the medical treatment process is divided into three stages:diagnosis,treatment and rehabilitation.The medical path of mild and severe patients in the medical alliance is analyzed,and the allocation of medical resources among all levels of medical institutions in the medical alliance under the hierarchical diagnosis and treatment mode is systematically and quantitatively studied.Through the analysis of the operation mechanism of the medical alliance under the hierarchical diagnosis and treatment mode,a more practical queuing network model with priority and blocking is established.In the model,the actual situation such as the classification of patients and the phased medical service process are fully considered,and the medical path of patients in the medical alliance is reconstructed.The results of numerical experiments show that a)in the short term,more patients should be transferred from hospitals to primary medical institutions for rehabilitation.When the referral rate is large,the rehabilitation medical resources of primary medical institutions should be appropriately increased;b)in the long term,mild patients should go to primary medical institutions,and severe patients should go to hospitals.When the quality of primary medical care is improved to a higher level

关 键 词：分级诊疗 排队网络 医联体 资源配置 系统优化 

分 类 号：C930[经济管理—管理学]