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论文编号：	12393
作者编号：	2120192794
上传时间：	2021/6/10 11:54:07
中文题目：	考虑患者意愿的分级诊疗转诊决策研究
英文题目：	Research on Decision-Making of Hierarchical Diagnosis and Treatment Referral Considering Patients'''' Willingness
指导老师：	梁峰
中文关键字：	分级诊疗；双向转诊；患者意愿；累积前景理论
英文关键字：	graded diagnosis and treatment; two-way referral; patient willingness; cumulative prospect theory
中文摘要：	自2009年深化医药卫生体制改革以来，推行分级诊疗制度一直是我国医疗卫生领域的重中之重。建成分级诊疗制度有助于促进各级医院之间转诊，缓解大医院诊疗压力，解决患者看病难、看病贵的问题。然而相关政策文件陆续出台，医疗体系内“上转容易下转难”的现状依旧没有改善。群众倾向前往大医院，小病去大医院的现象不断出现，使得基层医疗机构资源闲置，大医院则走上规模化扩张的道路。本文意图通过调节医疗保险报销比例以及增加转移支付补偿等方式来增强患者下转意愿，促使医院积极转诊，增加系统内转诊量，以期实现患者合理分流、有序就医。 本文以患者自身转诊意愿为切入点，构建了一个由一家三级医院、一家二级医院以及异质患者组成的分级诊疗模型，并分析了只考虑下转的分级诊疗模型、考虑上下转诊的完全考虑患者意愿以及部分考虑患者意愿的分级诊疗模型。患者基于累积前景理论评估各级医院，医院基于自身效益最大化的原则进行转诊决策，各参与方的决策过程服从多阶段的序贯博弈模型。使用逆向归纳法推导得出博弈均衡解，并通过数值模拟得到如下结论：（1）调节医疗保险报销比例可以促使部分患者前往下级医疗机构，增大下转量。（2）将患者等待时间指标纳入医院的绩效评价机制，可提高医院转诊意愿，促进上下转诊。（3）当患者等待时间对医院影响较小时，增加转移支付补偿费用可有效促进下转；当患者等待时间对医院影响较大时，医院本身有较强的转诊意愿，增加转移支付补偿费用对下转量没有显著影响。 根据模型结论，结合国外运行分级诊疗制度的经验，给出如下管理启示：（1）积极推行医保报销比例差异化政策，优化报销流程，扩大报销范围。（2）将患者等待时间、转诊量等因素纳入医院绩效考评体系。（3）积极推动医联体建设，构建各级医院之间的利益共享机制。（4）政府主导各级医院签订协商转诊量的三方协议。
英文摘要：	Since the deepening of the medical and health system reform in 2009, the implementation of the hierarchical diagnosis and treatment system has always been the top priority in our country's medical and health field. The establishment of a hierarchical diagnosis and treatment system will help promote referrals between hospitals at all levels, ease the pressure of diagnosis and treatment in large hospitals, and solve the problems of difficult and expensive medical treatment for patients. However, relevant policy documents have been issued one after another, and the status quo of ‘upward turning easy and downward turning difficult’ within the medical system has not improved. The masses tend to go to big hospitals, and the phenomenon of going to big hospitals for minor illnesses is constantly appearing, leaving the resources of primary medical institutions idle, and big hospitals are embarking on the road of large-scale expansion. This thesis intends to increase the willingness of patients to transfer by adjusting the proportion of medical insurance reimbursement and increasing transfer payment compensation, prompting hospitals to actively refer, increase the number of referrals in the system, in order to achieve reasonable diversion and orderly treatment of patients. Based on the patient's own referral willingness as the entry point, this thesis constructs a hierarchical diagnosis and treatment model consisting of a tertiary hospital, a second-level hospital, and heterogeneous patients, and analyzes the hierarchical diagnosis and treatment model that only considers down-transfer, and considers up-and-down transfer at the same time. A hierarchical diagnosis and treatment model that fully considers the wishes of patients and partly considers the wishes of patients. Patients evaluate hospitals at all levels based on cumulative prospect theory, and hospitals make referral decisions based on the principle of maximizing their own benefits. The decision-making process of each participant is subject to a multi-stage sequential game model. Using the reverse induction method to derive the game equilibrium solution, and through numerical simulation, the following conclusions are obtained: (1) Adjusting the proportion of medical insurance reimbursement can prompt some patients to go to lower-level medical institutions and increase the amount of down-transfer. (2) Incorporating patient waiting time indicators into the hospital's performance evaluation mechanism can increase the hospital's willingness to referral and promote upper and lower referrals. (3) When the patient's waiting time has a small impact on the hospital, increasing the transfer payment compensation fee can effectively promote downward transfer; when the patient's waiting time has a greater impact on the hospital, the hospital itself has a strong willingness to referral and increase the transfer payment compensation fee There is no significant effect on the amount of downturn. According to the conclusions of the model, combined with the experience of operating a hierarchical diagnosis and treatment system abroad, the following management implications are given: (1) Actively implement the policy of differentiation of medical insurance reimbursement ratio, optimize the reimbursement process, and expand the scope of reimbursement. (2) Incorporate factors such as patient waiting time and referral volume into the hospital performance appraisal system. (3) Actively promote the construction of medical consortia, and build a benefit-sharing mechanism among hospitals at all levels. (4) The government leads hospitals at all levels to sign a tripartite agreement to negotiate the amount of referrals
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