基于病人意愿的医院转诊策略研究

Study on hospital referral strategy based on patient's will

在国家倡导分级诊疗和医疗联合体制度的背景下,病人非理性就医和转诊制度的不完善,往往导致向下转诊困难等问题,使得大医院资源紧缺、小医院资源闲置的状况仍无法缓解。为探讨最优的医院转诊策略,文章在结合考虑转诊过程中病人的择医意愿和权利以及如何妥善接受向下转诊的建议等因素的基础之上,对病人在医疗联合体内两家医院的向下转诊机制建立马尔可夫决策过程模型,从系统诊疗人数的角度研究病人意愿对转诊的影响,发现推荐转诊的控制策略是随状态变化的开关曲线,状态降到该曲线以下时是推荐病人向下转诊的契机。

Against the background of the advocacy of hierarchical medical system and healthcare alliance system in China, the non-rational health seeking of patients and the incompleteness of referral system always lead to the diffculty of downward referral and make it hard to relieve the shortage of resources in big hospitals and the idleness of resources in small ones. To discuss the optimal hospital referral strategy, based on the considerations of patient＇s doctor selection will and how to properly accept the suggestion of downward referral, the paper builds a Markov decision process model for patients＇ downward referral mechanism of two hospitals in a healthcare alliance to study the impact of patient＇s will on referral from the angle of the number of patients in the system and fnds that the control strategy for referral recommendation is a switching curve varying with state and it＇s the opportunity to recommend downward referral to patient when the state falls under the curve.