Research On The Medical Outpatient Service Mode And Medical Insurance Payment Scheme Based On Queueing Economics

At present,there is a serious imbalance between the supply and demand of medical service resources in China,the problem of overtreatment behavior of healthcare service provider is still serious,the social problem of ”difficult and costly to see a doctor” for patients is still prominent.It is urgent to deepen the reform of the medical and health system,allocate medical resources rationally,and standardize the behavior of healthcare service provider.Hierarchical healthcare and online inquiry service mode are effective measures to alleviate the problem of mismatch between the supply and demand of medical resources,and help solve the ”difficult to see a doctor”problem of patients.A scientific and effective medical insurance payment scheme is an important medical reform policy to regulate medical behavior and control medical outpatient expenses,helping to alleviate the problem of ”costly to see a doctor”.However,the implementation effects of the above policies still failed to meet expectations.The main reason is that the particularity of medical services,the behavioral characteristics of patients and healthcare service provider,and the delay sensitivity of patients have a greater impact on the operation and management of the medical outpatient service system,the impact mechanism is complicated.Therefore,how to design a scientific and reasonable hierarchical medical outpatient service mode and medical insurance payment scheme has important theoretical and practical significance for the effective operation and management of Chinese medical outpatient service system.Based on above background,this thesis intends to explore the impact of the behavioral characteristics of patients and healthcare service provider on the operation and management of medical outpatient services from the perspective of queueing economics,in order to coordinate the precise matching of medical outpatient service resources and the development of the medical system in China,formulate outpatient service models and innovative medical insurance payment schemes,and conduct an in-depth analysis of the effective operation strategy of the medical outpatient service system.The main research content of this thesis are as follows:(1)Research on the hierarchical medical outpatient service mode based on the gatekeeping system and the non-gatekeeping system.In the hierarchical medical outpatient service system facing delay-sensitive patients,a three-stage sequential game model is established to study the gatekeeping system that restricts patients’ behavior and the unconstrained non-gatekeeping system,explore the impact of the behavioral strategies of patients and service providers with different service capacity(community hospital and tertiary hospital)on the performance of the hierarchical medical outpatient service system,and evaluate the advantages and disadvantages of the two systems and market application conditions.The result shows that the choice of the two systems depends on two key factors: the service capacity of the tertiary hospital and the medical service level of the community hospital.The gatekeeping system is better than the nongatekeeping system only when the service capacity of the tertiary hospital is relatively low(the contradiction between supply and demand in the medical market is more prominent)and the medical service level of community hospital is high.However,this conclusion is conditional.When the capacity of the tertiary hospital is high or the medical service level of the community hospital is low,the introduction of the gatekeeping system worsens the performance of the entire medical system.If the service capacity of the tertiary hospital is relatively high,the gatekeeping system will make the service provision of the community hospital appear to be ”superfluous.”If the medical service level of the community hospital is too low,the gatekeeping system will cause too many patients to experience ineffective service.(2)Research on hierarchical medical outpatient service mode based on online inquiry service.Under the gatekeeping system,the diagnosis ability of general practitioner is different between online and traditional offline services,that is,due to the lack of face-to-face detailed consultation and examination,general practitioner has weaker diagnosis ability when working online.By building a sequential game model,this thesis evaluates the impact of the online medical service mode that introduces online inquiry service and the traditional medical service mode that does not introduce online inquiry service on system performance.We find that,due to the weak online diagnosis capabilities,although the introduction of online inquiry service reduces the transportation cost of patient,it increases the probability of patients being referred to specialists because of misdiagnosis,increases the overall waiting time,and reduces the patient’s health surplus.In addition,when patients are not sensitive to delay,the introduction of online inquiry service can improve total patient welfare;when patients are sufficiently sensitive to waiting,the online medical service mode will impair patient welfare.(3)Research on bundled payment of medical outpatient service based on cost-speed tradeoff.Considering that the service rate of healthcare service provider will affect medical cost,a three-stage sequential game queuing model is established to study the impact of the innovative medical insurance payment scheme-bundled payment on the performance of the outpatient service system.The study find that bundled payment can only achieve the first-best optimum(the maximization of social welfare under centralized decision-making)under certain condition.When the medical budget is high enough,the administrator can guide the hospital to choose the first-best decision by setting the optimal price under the bundled payment.However,when the budget is in the middle,the hospital’s equilibrium service speed will be set slower than the firstbest service speed to control medical cost and maintain profit margin.At this time,the administrator can add the service level regulation for the hospital based on the bundled payment-the patient’s expected waiting time cannot exceed a standard,so as to encourage the hospital service faster and achieve the first-best optimum.When the budget is low enough,no hospital is willing to provide service because it is unprofitable.In addition,as the intensity of competition between the hospitals increases,it is easier to maximize social welfare under bundled payment.This paper proposes service modes and innovative medical insurance payment scheme that promote the precise matching of the supply and demand of medical outpatient service resource,enriches the theoretical research on medical service operation management,and reveals the operation mechanism of the medical outpatient service system in China.It provides theoretical support and scientific basis for the construction of a more reasonable and effective medical outpatient service system,and has high application value and reality for optimizing the allocation of medical service resources,alleviating excessive medical behavior,and solving ”difficult and costly to see a doctor” problem.