紧密型与松散型医联体的下转效率对比研究

Comparison of downstream referral under the subordination and subcontracting

三甲医院与社区医院的利益冲突使得下转项目难以实施,为此医保局鼓励医院构建医联体.而本文是首个从医联体结构角度出发,通过构建三阶段排队博弈模型来刻画医保局,两级医院和病人间的交互过程,并在此基础上,对比了紧密型和松散型医联体的下转效率.研究发现:1)紧密型医联体下,医保局制定的最优打包价格更低,但最优下转量更多,社区医院的努力程度更高.2)紧密型医联体的最优下转量(努力程度)总是多于社会最优情形;但只有当外部治疗成本较小时,松散型医联体的最优下转量(努力程度)才多于社会最优情形.3)当外部治疗成本较小时,松散型是帕累托改进策略;当外部治疗成本较大时,紧密型是帕累托改进策略.

The conflict of interest between tertiary hospitals and community hospitals makes it difficult to implement the downstream referral program,so the payer encourages hospitals to construct integrated healthcare systems to implement it.This paper is the first to construct a three-stage queueing game model to describe the interaction between the payer,hospitals and patients when considering the structure of integrated healthcare systems.On this basis,we focus on the comparison of the downstream referral under the subordination and subcontracting and find:1)In the subordination,the payer decides a lower bundled price,which leads to more downstream referrals and a higher effort level.2)Both the optimal downstream referral and effort level in the subordination are higher than that in the benchmark which minimizes total social cost;but the same result holds only when the unit delay cost is small in the subcontracting.3)When the unit delay cost is small,the subcontracting is a pareto improvement(PI);when the unit delay cost is large,the subordination is a PI.