面向分级诊疗的医疗资源配置决策研究

Medical Resources Allocation Contributing to Hierarchical Diagnosis

医疗改革的核心内容之一是如何合理配置有限的医疗资源，在制定政策对医疗资源进行配置时，功利性和公平性通常是相冲突的两个目标。基于健康效用理论，提出了权衡功利性和公平性的混合整数规划模型。公平性定义采用的是罗尔斯公平主义，当病人之间的健康效用差异不大时，采用公平主义标准，但当差异较大的时候，则采用功利主义标准。将模型应用到分级诊疗决策中，结果显示，对于治疗危重疾病应采用公平主义标准，将资源分配到高级别的医院；对于治疗常见轻微疾病应采用功利主义标准，将资源分配到低级别的医院。研究结果对卫生政策的制定具有理论指导意义。

How to make reasonable distribution of the limited medical resources is one of the core contents of the healthcare reform. Equity and utilitarianism are two conflicting objectives when making social policy to allocate medical resources. A mixed-integer programming model, which combines equity and utilitarianism, was proposed based on the concept of health utility. The Rawls＇s theory of justice was suggested in the model. When the disparity of utility was small, equity was adopted. However, the objective became utilitarian once the disparity becomes great. Numerical modeling was applied and the result shows that equity criterion should be adopted to treat critical diseases,while utilitarianism criterion should be adopted to treat mild diseases. The results of the study have theoretical guiding significance for making health policy.