基于系统动力学模型对我国推行分级诊疗体系的影响因素分析

Analysis on the Influencing Factors of Hierarchical Diagnosis and Treatment System Based on System Dynamics Model in China

目的为建设健康中国,进一步完善分级诊疗体系提供对策建议。方法从基层首诊和双向转诊入手,运用系统动力学对推行分级诊疗体系的影响因素进行模拟分析。结果基层医疗机构服务质量有待提升,加上基层缺乏优质的设施、设备条件,医院医师下转积极性不强,医疗保险差异化比例不明显等问题影响了基层首诊率的提高和双向转诊的顺利推行。结论为推进健康中国建设,完善分级诊疗体系,应提高基层医疗机构的实力,推进基层首诊,加强医疗机构之间的分工协作,实现双向转诊,合理调整医疗保险报销差异化比例,加强医疗保险的激励与约束机制。

Objective In order to promote healthy China, we should provide suggestions to further improve the classification system.Method The factors influencing the establishment of the hierarchical diagnosis and treatment system were analyzed by using the system dynamics from the first and the two-way referral.Results Grass-roots medical institutions to improve the quality of service,coupled with the lack of quality facilities at the grassroots level,equipment conditions,the enthusiasm of the hospital doctor is not strong,the proportion of medical insurance differentiation is not obvious and other issues affect the grass-roots first rate of improvement and the smooth implementation of two-way referral.Conclusion In order to promote the healthy China construction,improve the hierarchical diagnosis and treatment,we should improve the strength of grassroots medical institutions, promote grassroots first diagnosis,strengthen the division of labor between medical institutions to achieve a two-way referral, reasonable adjustment of the proportion of medical insurance reimbursement differences,strangthen health insurance incentives and restraint mechanisms.