Research On Real-time Referral Policy Under The Consideration Of Willingness Of Patients

Mutual referral system has been implemented for years to restore reasonable distribution of patients and promote the formation of tiered health care system in China.Medical alliance is an effective measure to stimulate patient referral and association between different-level hospitals,and many local governments already have piloted medical alliance.However,the implementation of downward referral still did not achieve satisfactory results,whose original purpose is to relieve the medical pressure of high-level hospital.To promote the downward referral process,medical alliance with group mode is set as research background,in which different-level hospitals develop association via benefit-sharing and resource-sharing.Under this background,we research the downward referral problem.Downward referral occurs on common,chronic and convalescent patients in high-level hospital,who are supposed to transfer to low-level hospitals.Owing to the undeveloped primary health care institutions in our country,taking patient choice into account is very important when high-level hospital decide to transfer patients toward low-level hospital.Therefore,the downward referral process respect patient’s willingness,patients is the final decision maker of downward referral.Downward referral cannot happen if patient rejects even if high-level recommend strongly.First,we determine the influence of related parameters on patient’s willingness to referral through questionnaires.Related parameters include healthcare quality,hospital collaboration,healthcare price,etc.Findings verify the effectiveness of related measures in subsequent model.Then,a downward referral model of "hospital guide" and "patient decision" is established.Objective function of the model is the overall benefit of the medical alliance.Through the Markov decision process,we can find the optimal referralrecommendation strategy for large hospital,which optimizes the system benefits.At the same time,specific optimal referral-recommendation strategy are found when parameters such as patient arrival pattern,healthcare price and patient’s medical insurance co-payment ratio change.Conclusions drawn from numerical simulation are as follows:(1)The optimal referral-recommendation strategy for large hospitals follows the threshold structure,which is related to the decision stage and the status of system.(2)The greater the healthcare price difference of the same diseases treated in different-level hospitals,the more negative the large hospital participate in downward referral.Therefore,Medicare payment must change from Fee-forService to Diagnosis Related Groups as soon as possible.(3)The greater gap the Medicare reimbursement ratio between different-level hospitals,the higher the threshold is when large hospital start to recommend patients transfer to low-level hospital.The expanded Medicare reimbursement gradient can reduce the difficulty of transferring patients for large hospitals.