考虑资源下沉与家庭签约的医联体多目标协调优化决策  

Multi-objective Optimization of Medical Association Coordination Considering Sinking High-quality Medical Resources and Family Contract Services

作　　者：隆清琦 刘杰鹏 彭娟娟 张树柱 LONG Qingqi;LIU Jiepeng;PENG Juanjuan;ZHANG Shuzhu(School of Information Technology and Artificial Intelligence,Zhejiang University of Finance and Economics,Hangzhou 310018,China)

机构地区：[1]浙江财经大学信息技术与人工智能学院,浙江杭州310018

出　　处：《运筹与管理》2024年第12期24-31,共8页Operations Research and Management Science

基　　金：国家自然科学基金资助项目(72171208,71771195);之江实验室开放课题(2021KG0AB04)。

摘　　要：资源下沉与家庭签约是推进医联体建设与发展的关键战略之一,对医疗资源配置优化具有重要意义。本文建立考虑三级医院资源下沉与社区医院家庭签约的双向转诊医疗服务供应链计算实验模型;围绕三级医院收益、社区医院患者到达率以及患者群体感知效用等目标函数,结合患者的病情轻重、自我诊断与个人偏好等随机因素,探索多目标进化算法所求解的帕累托前沿面;基于前景理论和Dematel-熵权法对最优帕累托前沿面进行VIKOR排序,得到了三种决策者偏好下的折衷方案。一个医疗服务供应链案例被用于验证研究框架的可行性与合理性,且案例结果显示该研究框架能有效处理三级医院、社区医院和患者群体间的协调优化决策问题,具有较强的方法论的有效性和结论的可靠性。本文在医联体内创新性地兼顾资源下沉与家庭签约,集成计算实验、多目标进化算法和改进的VIKOR排序至同一研究框架,有效提高了管理者的决策质量和能力,促进医疗服务供应链良性运作。There is a serious issue of an imbalanced utilization within the current healthcare system,and how to effectively improve the utilization of public health resources while taking into account the public welfare nature of healthcare services has become a difficult problem for the government.To improve the service level of primary institutions in the hierarchical medical system,the measures of sinking high-quality medical resources from tertiary hospitals to community ones and implementing family contract services in community hospitals have been widely used.However,tertiary hospitals pay more attention to the operating income,while community ones to the patient arrival rate.The two goals are in conflict.For example,a high proportion of resources sinking can improve the medical service of community hospitals,but will affect the operating income of tertiary ones.A high proportion of family contract investment can attract more patients to community hospitals for medical treatment,but will affect their capacity construction.Therefore,the proportion of resources sinking and that of family contract investment are important variables affecting the coordination of medical association.To sum up,resources sinking and family contract service are the key strategies to promote the construction and development of medical association,which is of great significance to the optimization of medical resources allocation.Influenced by many random factors,our study explores the impacts of the proportion of tertiary hospital’resources sinking and that of community hospital’family contract investment on the objectives of both tertiary and community hospitals,so it improves the research background in the field of medical association coordination and optimization,and has practical significance.We provide a feasible research framework for the issue of medical service supply chain,which is of theoretical innovation significance.Considering that a dual-way referral is a key part of medical association,this paper takes the dual-way referral

关 键 词：医联体协调 资源下沉 家庭签约 多目标优化 决策制定 

分 类 号：C939[经济管理—管理学] R197.32[医药卫生—卫生事业管理]