基于系统动力学的患者社区首诊影响因素研究

目的探究患者社区首诊影响因素，为政策制定提供参考。方法根据患者社区首诊动力的结构分析和历史数据与文献资料，搭建医联体合作动力架构，建立系统动力学模型，完成模型修正和检验以及敏感性分析。结果通过模型仿真发现，患者对价格敏感程度较高，提高社区医院医保报销比例、降低社区就诊费用可以有效吸引患者到社区首诊；加强社区首诊宣传也是十分有效的手段；扩充社区药品种类措施有效，但作用有限；增加政府卫生财政投入收效甚微。结论采用系统动力学方法建模可更加全面地对居民选择社区首诊的问题进行量化研究，关键参数预测对比验证了模型的有效性，对不同政策的模拟结果更加直观。相关部门应提高社区就诊医保报销比例，降低社区就诊费用，加强社区首诊宣传，合理扩充社区药品种类。

Influencing Factors of Patients'Community First Visit Based on System Dynamics

Objective To investigate the influencing factors of patients'community first visit,and provide reference for policy making.Methods According to the structural analysis of patients'community first visit motivation,historical and literature data,a dynamic framework for medical association was built,a system dynamics model was constructed,modified and tested,and sensitivity analysis was completed.Results The model simulation showed that patients were highly sensitive to price.Increasing the proportion of community medical insurance reimbursement and reducing the cost of community medical treatment could effectively attract patients to the community for the first visit,and strengthening the publicity of the community first visit was also a very effective method.Extending the drug category of community could also help,but not that much as expected,and the increase of government financial spending on health had little effect.Conclusion Using system dynamics modeling method for the problem of patients'community first visit had carried on a quantitative research in a more comprehensive way.The comparison of the predicted key parameters verified the validity of the model,and the simulation results of different policy were more intuitive and more quantitative.The relevant departments should improve the proportion of medical insurance reimbursement in the community,reduce the cost of the community visit,strengthen the publicity for community first visit,and expand the drug category of community.