基于患者选择行为的医疗服务市场动态决策

Dynamic decision-making of market of medical service based on choice behavior of patients

医疗体制改革是各国政府近年来相继提出的战略任务。相比其它市场化程度很高的经济系统,医疗系统往往因其公益性难以进行模型化研究。通过霍特林模型刻画公立和私立医院并存的医疗服务市场,建立以极大化病人效用和公立医院收益总和为目标函数的动态决策模型。通过庞特里亚金极大值原理给出公立医院决策看病数量,并分析公立医院决策看病数量、平均等待时间和瞬时目标函数随时间的变化趋势。站在病人角度分析对等待时间敏感程度、对距离成本敏感程度以及对价格成本敏感程度对其就医选择的影响。最后,结合数值模拟验证了模型有效性,并分别针对政府、医院和病人提出合理化建议。

Medical system reform has been a strategic task proposed by the governments of many countries in recent years.Compared with other highly market-oriented economic systems,medical system is often difficult to study by modeling because of its characteristics of public welfare.Hotelling model is applied to describe the market of medical services in which public and private hospitals coexisted,and dynamic model of decision-making is established with maximum utility effect of patient and total income of public hospital as its objective function.The decision-making of amount of medical treatment in public hospital is given through the maximum principle of Pontryagin,and the changing trends of decision-making of amount of medical treatment,average waiting time and instantaneous objective function in public hospitals over time are analyzed.From the perspective of patients,the influences on their medical choice are analyzed of the sensitivities on waiting time,distance cost and price cost.Finally,the effectiveness of model is validated with numerical simulation.Rational suggestions are proposed for the government,hospitals and patients respectively.