分级诊疗制度下考虑患者偏好的医疗服务资源纵向整合研究

分级诊疗制度是现阶段改善患者无序就医、合理配置医疗资源、促进基本医疗服务均等化的重要举措。本文界定了个人可支配收入、年龄、自感疾病严重程度及医疗机构门诊价格、服务容量等多因素影响的患者理性就医行为的效用函数,构建了基于患者就医偏好的就医选择动态博弈模型,通过将理性就医偏好下虚拟行动仿真的秦皇岛医疗机构患者分布与实际统计数据进行比较,验证了所建模型的合理性。研究结果表明:患者在基层医疗机构与高水平医疗机构间的就医行为较理性,在二三级医院间却较不理性。因而分级诊疗制度下医疗服务资源优化的重点在于建立患者按需就医的整合型医疗服务体系。

Study on longitudinal integration of medical service resources considering patients' preference in tiered medical care system

The hierarchical diagnosis and treatment system is an important measure for rational allocation of medical resources, promotion of equalization of basic medical services, improving the patients'' disorderly medical treatment and guiding patients'' hospital choice behavior. This paper defines the utility function of rational medical treatment of patients affected by multiple factors such as the personal disposable income, the age, the severity of the self-induced illness and the decision-makers'' education level, and considered the outpatient price, service capacity and other factors of medical institutions. The present study constructed the incomplete information dynamic game model based on fictitious play method. It provided the quantitative analysis of the statistical data of Qinhuangdao and obtained the patients distribution in medical institution. The rationality of the model was verified by comparing the simulation with actual data, and showed the choice is more reasonable between the primary health care and general hospital. Therefore, the emphasis of optimizing the medical service resources in hierarchical diagnosis and treatment system is to establish the treatment system of integrated medical service for patients'' on-demand and on-demand medical services. At the same, various incentives should be used to enhance patients'' enthusiasm for primary health care.