医联体服务模式下医疗资源分配与协调契约
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Allocation strategies and coordination contracts of high-quality medical resources based on hospital association service mode
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    摘要:

    基于以医联体为载体促使分级诊疗服务有效发展的情形,研究政府与医院合作协调优质医疗资源配置的契约机制及医联体运作的影响机理.通过构建一个四阶段博弈理论排队模型,分析患者、医联体内多家社区医院和三级医院以及政府各参与主体之间的动态决策关系,进而给出患者就诊率、社区医院能力规划、三级医院资源下沉率及政府补贴价格与协调各家社区医院共享利益的支付价格的均衡决策.研究发现,资源无下沉情况下,社区医院越多,越有利于缓解三级医院和医疗系统拥挤程度、提升患者福利;中等社区医院数量更有利于社会福利提升.而资源下沉情况下,社区医院越少,越有利医联体促使资源下沉落实以及系统效能提升.社区医院服务能力成本越高,政府主导组建的医联体内成员数量应该越少.数值实验表明,对三级医院补偿中,就诊社区医院患者增加率的关切度较低或较高,更有利于政府节约补贴资金,特别是对于紧缺补贴预算,更有利社会福利提升.提出的协调医联体优质医疗资源有效配置的契约机制,能为政府建立科学的分级诊疗系统提供理论决策支持,对提升医疗服务整体效能也有较高的应用价值.

    Abstract:

    Based on the situation of promoting the effective development of hierarchical healthcare services through hospital associations, this paper studies the contractual mechanism of cooperation between the government and hospitals in coordinating the allocation of high-quality medical resources as well as the mechanism of the operations of hospital associations. By developing a four-stage game-theoretic queueing model, this paper analyzes the dynamic interaction relationships among patients, multiple community hospitals, and tertiary hospitals in a hospital association, and government. Next, this paper presents the equilibrium decisions in terms of patients’ arrival rate, community hospitals’ capacity planning, the tertiary hospital’s resource sinking rate, and the government’s subsidy price, and each community hospital’s profit-sharing price. It finds that, in the absence of resource sinking, the more community hospitals there are, the more conducive they are to reducing the congestion of tertiary hospitals and the healthcare system and improving the welfare of patients. Furthermore, the medium number of community hospitals is more conducive to the improvement of social welfare. By contrast, the fewer the community hospitals, the more favorable the hospital association is to promoting the implementation of the resource-sinking program and improve the effectiveness of the system. When the community hospital’s capacity cost per unit is higher, the maximum number of members in the government-formed consortium should be the smaller. Numerical experiments show that in the process of compensating a tertiary hospital, when the concerned degree of the increase in the rate of patients visiting community hospitals is relatively low or high, the government could save subsidy funds. Specifically, in the case of limited subsidy budgets, this is particularly beneficial for the improvement of social welfare. This paper proposes the contract mechanisms for coordinating the effective allocation of high-quality medical resources in a hospital association. This provides theoretical decision support for the government to establish a scientific hierarchical healthcare delivery system. At the same time, this paper has a high application reference value for improving the overall efficiency of healthcare services.

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李忠萍,王建军.医联体服务模式下医疗资源分配与协调契约[J].管理科学学报,2025,(5):84~104

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  • 在线发布日期: 2025-05-22
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