考虑患者行为的医疗联合体协同优化研究

Nowadays, the healthcare service demand induced by residents in China has the following three characteristics: large quantity, high quality, and heterogeneous. Meanwhile, the multiple healthcare service providers have been transformed from independent operators to the healthcare alliance. The crucial feature of the healthcare alliance is that heterogeneous patients are classified before being treated in different levels of healthcare facilities, so that the heterogeneous demand can be satisfied at the same time, which further reduces the healthcare expenditure. In order to promote the positive effect of classified treatment on the healthcare system, this research models the bounded rationality of patients whose behavior is influenced by both objective and subjective factors during the service process. Furthermore, we propose a win-win incentive mechanism among multi-agent healthcare facilities in the strategic level, where the heterogeneity of patients’ demand and the effect of patients’ behavior on the optimal incentive mechanism are considered. By using contract design to allocate the service capacity among multiple agents, we determine the optimal pricing policy, so as to maximize the overall social welfare. Finally, the dynamic resource sharing policy among healthcare facilities in the operational level under the equilibrium of mechanism design is discussed. The main contribution of this research is to extend the theoretical study of behavioral operations research in healthcare. In practical perspective, insights of the theoretical results provide technical support to the healthcare alliance, a typical union of service provider, with limited resources, and a win-win collaboration mode. Additionally, we also release quantitative instruction of resource sharing to multiple agents in the operation level of the healthcare alliance.

新时期居民对医疗服务呈现出高需求，高标准和异质性的特点，而医疗服务提供从各类机构独立供给转变成为医疗服务联合体的形式。为促使医疗联合体发挥分级诊疗的功效，满足居民不同的医疗服务需求，降低总的医疗成本，本研究以医联体为背景，首先通过对患者医疗服务过程中受客观、主观等多因素影响而形成的“有限理性”行为进行建模研究。进一步从战略层研究医联体内多主体医疗机构间的双赢激励机制，针对患者需求异质性的特点，考虑患者就诊行为对医联体组成主体间协同优化激励机制的影响；通过合同设计医联体多主体间的服务能力分配与保险最优定价，实现社会福利最大化。最后从运作层研究机制设计均衡条件下的医疗服务机构间的资源动态共享策略。本研究将拓展行为科学在医疗服务领域的理论研究，对以“医联体”为代表特征的服务联合体在资源有限情况下制定双赢的合作模式提供决策支持，在运作层面对医联体多主体间资源共享策略提供量化指导 。

在居民对医疗服务呈现出高需求，高标准和异质性的特点、医疗服务从各类机构独立供给转变成为医疗服务联合体的形式的背景下，为促使医疗联合体发挥分级诊疗的功效，满足居民不同的医疗服务需求，降低总的医疗成本，本研究以医联体为背景，通过对患者医疗服务过程中受客观、主观等多因素影响而形成的“有限理性”行为进行建模研究。在此基础上，本研究从战略层面对医联体机制设计进行优化，关注医联体内多主体医疗机构间的双赢激励机制，针对患者需求异质性的特点，考虑患者就诊行为对医联体组成主体间协同优化激励机制的影响；通过合同设计医联体多主体间的服务能力分配，实现社会福利最大化，为目前我国的医联体实践提供理论参考。在具体运作层面，依托于高速发展的在线医疗平台对患者选择行为进行引导，基于实时数据和信息，针对医患动态匹配过程进行建模优化，设计了高效且表现有理论保障并经过实际数据验证的医生推荐或指派算法，提升医疗资源的配置效率。本课题提取了医疗服务系统和在线医疗平台的典型特征进行模型构建，对模型进行求解以分析最优策略的性质，提供实际管理建议，或提出相应的算法，为在有限优质医疗资源下进一步提升我国医疗资源的利用效率、提升居民就医满意度提供了有效的理论参考依据和量化解决方案。