防御型治疗仅是医生的责任吗?  

Is defensive medicine only the responsibility of physicians?

作　　者：吴晓丹[1] 商博雅 岳殿民[1] Chu Chao-Hsien Wu Xiaodan;Shang Boya;Yue Dianmin;Chu Chao-Hsien(School of Economics and Management,Hebei University of Technology,Tianjin 300401,China;College of Information Sciences and Technology,Pennsylvania State University,PA 16802,USA;CATARC Automotive Industry Engineering(Tianjin)Co.,Ltd.,Tianjin 300300,China)

机构地区：[1]河北工业大学经济管理学院,天津300401 [2]美国宾夕法尼亚州立大学信息科学与技术学院,PA 16802 [3]中汽研汽车工业工程(天津)有限公司,天津300300

出　　处：《系统工程学报》2024年第4期514-536,共23页Journal of Systems Engineering

基　　金：国家社会科学基金重点资助项目(23AGL018);河北省教育厅人文社会科学研究重大课题攻关资助项目(ZD202305,ZD202210)。

摘　　要：医患共享决策背景下,独辟患者角度分析其诊疗需求对医生防御型治疗行为影响.建立演化博弈模型,特别抓取患者风险规避程度这一显著特征内生化诊疗需求,分析医患行为变化,并探究医患策略随患者患病程度的演变规律.研究表明,患者风险规避程度低于特定阈值则诱发防御型治疗,且促使患者接受度提升.此外,在患病程度对患者拒绝行为促进作用下,应重点关注医生轻疾诊疗决策并降低防御型治疗经济激励.研究结论对改善患者风险规避程度,设置差异化声誉惩罚,制定重大疾病补贴政策,DRGs定额支付方式推广与医养结合服务项目延伸等具有借鉴价值.Against the backdrop of doctor-patient shared decision-making,the influence of patients'treatment needs on doctors'defensive treatment behaviors is analyzed from the perspective of unique patients.An evolutionary game model is developed to analyze changes in physician-patient behavior by specifically cap turing patients'risk aversion degree-A remarkable feature of endogenous treatment needs.The model aims to examine doctor-patient behavior change and explore evolution rules of doctor-patient strategy responding to patients'illness degree.According to the study results,if a patients'degree of risk aversion is lower than a certain threshold,it will induce defensive treatment and promote patient acceptance.Besides,considering the promotion effect of disease severity on patients'refusal behavior,the focus should be on physicians'decisions to treat minor illnesses and reduce financial incentives for defensive treatment.The findings have reference value for improving patients'risk aversion,setting differential reputation punishment,developing subsidies for major diseases,popularizing DRGs fixed payment mode,and extending integrated eldercare services with medical care.

关 键 词：防御型治疗 患者风险规避 演化博弈 患者患病程度 声誉惩罚 

分 类 号：TP273[自动化与计算机技术—检测技术与自动化装置]