首页|基于演化博弈的我国分级诊疗策略分析

基于演化博弈的我国分级诊疗策略分析

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目的 在分级诊疗制度中涉及政府、医院和患者之间的利益关系,探讨三方动态博弈策略,有利于完善分级诊疗的理论范式和政策逻辑.方法 构建政府、医院和患者三方模型,分析其策略选择及演化路径,求解三方演化博弈的稳定策略,探究如何进行利益平衡和合作以实现三方共赢.另外,利用Matlab R2018b对模型进行仿真,进一步分析三方主体的演化路径以及不同策略选择对分级诊疗制度推广的影响.结果 政府、医院和患者3个主体的决策行为之间相互影响,最终将演化至点(1,1,1)的理想稳定状态.增大政府补贴会加速医院和患者的初始参与概率值收敛至1,但过多的补贴会使政府逐渐背离鼓励分级诊疗的策略.结论 政府应在成本范围内加大对医院优质医疗资源下沉的专家补贴力度,并加强政府监管.大型医院和基层医疗卫生机构重要的是实现医生资源的自由流动和合理分布.患者还需转变固有的就医观念,才能最终实现有序就医.
Strategy Analysis of Tiered Diagnosis and Treatment Based on Evolutionary Game
Objective To explore the tripartite dynamic game strategy involving the interest relationship between government,hospital and patients in the tiered diagnosis and treatment system,which is conducive to improving the theoretical paradigm and policy logic of tiered diagnosis and treatment system.Methods It built a tripartite evolu-tionary game model to analyse their strategy choices and evolutionary paths,and to solve for stable strategies in the three-way evolutionary game.MATLAB R2018b was used to simulate the model,and the evolution paths and the in-fluence of different strategy choices on the promotion of the tiered diagnosis and treatment system were further ana-lyzed.Results Government,hospitals,and patients will influence each other and eventually evolve to the ideal stable state(1,1,1).Increasing government subsidies will accelerate the convergence of the initial participation probability of hospitals and patients to 1,while excessive subsidies will gradually cause the government to deviate from the strategy of encouraging.Conclusions The government should restrict subsidies for high-quality medical resources to a reasonable range,attract hospital experts,and strengthen regulations.It is important for large hospitals and basic medical institutions to realize the free flow and rational distribution of the resources available to doctors.Patients need to change their inherent concept of medical treatment to achieve orderly medical treatment.

tiered diagnosis and treatment systemevolutionary gamemodel simulationevolution pathstrategy selection

宋杨、吴华章

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中国医科大学马克思主义学院 辽宁沈阳 110122

中国医科大学健康管理学院 辽宁沈阳 110122

分级诊疗 演化博弈 模型仿真 演化路径 策略选择

辽宁省经济社会发展研究课题中国医科大学青年英才培育计划(2021)辽宁省科学技术厅支持中国医科大学高质量发展科技资金项目辽宁省教育厅高校基金科研项目

2024lslqnkt-0162022JH2/20200033JYTMS20230139

2024

中国医院管理
中国医院管理杂志社

中国医院管理

CSTPCD北大核心
影响因子：2.15
ISSN：1001-5329
年,卷(期)：2024.44(2)
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