过度医疗与转诊制:一个排队论下的博弈模型
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F224.3; F280

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国家自然科学基金资助项目 (71473284; 71603298);


Overtreatment and referral systems: A game embedded in a queuing model
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    摘要:

    建立了一个转诊系统中排队和博弈的集成模型, 患者可能有轻微或严重型疾病, 而医生可能将轻微型疾病诊断为严重型疾病, 进行过度治疗.本文探究政府如何通过配置医院规模和调节医疗服务价格影响医患博弈, 使患者倾向于社区首诊、医生选择说实话.研究表明, 社区医院与三甲医院通过规模进行竞争, 社区医院规模越大或三甲医院规模越小, 诱导需求越能得到抑制.轻微型疾病治疗方案的价格较低时, 诱导需求以正概率存在;高于某阈值时, 诱导需求消失.提高严重型和轻微型疾病治疗方案的价差, 能够抑制诱导需求, 但不能完全消除, 也不能改善患者福利;和三甲医院相比, 社区医院在改善患者福利上效果更明显.

    Abstract:

    This paper develops an integrated model applying queueing theory and game theory for the referral system. Patients may have severe or moderate illness. Physicians could report moderate illness as severe illness and conduct overtreatment. This paper studies how a government could allocate the capacities of hospitals and adjust medical pricing to influence the physician-patient game so that the patients could get more primary care in community hospitals and the physicians could tell the truth. The study indicates that the community hospital competes with class 3-A hospitals via their capacities. Induced demand is restricted by larger community hospitals or smaller class 3-A hospitals. When the price of the treatment for moderate illnesses is low, induced demand occurs with positive probability; when that price is larger than some threshold, induced demand disappears. Raising the difference between the prices of treatments for severe and moderate illnesses could restrict induced demand, but could not eliminate it, nor could this action enhance patients' welfare. In enhancing patients' welfare, community hospitals are better than class 3-A hospitals.

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王文娟,王季冬.过度医疗与转诊制:一个排队论下的博弈模型[J].管理科学学报,2019,22(2):63~76

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  • 在线发布日期: 2021-10-25
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