系统动力学视角下区域纵向医疗联合体分级诊疗模拟分析

目标:研究区域纵向医疗联合体全国范围内实施情况下,模拟不同条件下社区首诊、双向转诊变化情况,并依据模拟结果,提出分级诊疗相关建议。方法:运用系统动力学方法模拟不同条件下社区首诊率、双向转诊率变化情况。结果:社区首诊率方面,政府增加技术性财政投入,提升社区卫生服务中心技术水平,社区首诊率提升幅度为0.08%-0.17%;双向转诊率方面,政府增加技术性财政投入以提升社区卫生服务中心技术水平,增加弥补性财政投入以减轻上级医院对轻病依赖,下转率提升幅度为0. 33%～0.45%;上转方面,政府增加技术性财政投入以提升社区卫生服务中心技术水平,上转率降幅为7.52%～12. 61%。结论:多元化政策促进分级诊疗的实现;实施差异化报销,发挥医保资源配置作用;加强供给侧改革力度;注重上下转诊的合理发展。

Analysis on the hierarchical medical system of regional longitudinal medical consortium based on system dynamics

Objective:To analyze the change in community first diagnosis and two-way referral rate under the condition of the regional longitudinal medical consortium implementation in the country at large. According to the simulation results, some suggestions for hierarchical medical system were put forward. Methods:The community first diagnosis and two-way referral rates were determined using the literature meta-analysis, and were simulated under different conditions by means of the system dynamics. Results:The analysis results confirmed that simply increasing the financial subsidies can increase the community first diagnosis rate within a range from 0.08% to 0.17%. For in case increases are made by the government in technical financial input to enhance the technical level of the community health service centers and in compensatory financial input to reduce the higher hospitals dependence on the light disease, results showed that the lower conversion rate increased within the range of 0.33%~0.45% in terms of the two-way referral rating. On the contrary, when technical financial input is increased to improve the technical level of community health service centers, the rate of change was in the range of 7.52%~12.61%. Conclusions:Firstly, the diversified strategy should be used to promote the achievement of graded diagnosis and treatment. Secondly, the Health Commission plays a key role in the promotion of themedical consortiumconstruction. Thirdly, medical insurance reimbursement differential strategy should be implemented and the supply-side reform should be strengthened. At last, attention should be paid to the rational development of existing referrals, especially the upper and lower ones.