Research On Two-way Referral Decisions In The Medical Consortium

For a long time,tertiary hospitals are overcrowded and community health service institutions are often idle in China.Even for simple or basic medical services,most patients in China tend to go to tertiary hospitals.This situation has led to serious social problems,and the imbalance of medical resources has greatly reduced the efficiency of medical services.Therefore,the government set out to build a medical consortium,to promote the vertical sinking of high-quality medical resources,to solve the problems of difficult medical treatment in tertiary hospitals,and to promote the formation of a graded diagnosis and treatment mode of first diagnosis and two-way referral at the grass-roots level,so as to realize the rational diversion of patients.Up to now,the construction of medical association has been quite effective,but there are still obstacles and challenges in its implementation,especially the loose medical association.The main problems are unclear income distribution mechanism and low primary medical service capacity.Based on this,this paper takes the two-level medical service system composed of tertiary hospitals and community hospitals as the research object,describes the process of two-way referral between hospitals in the medical association,establishes the mathematical model of two-way referral based on newsboy model,and carries out numerical simulation analysis on the function according to the medical data published by the Health and Health Commission.Firstly,the situation of compact medical association,that is,centralized decision-making,is analyzed,and the optimal downward rate of the system is sought.The analysis results show that:(1)in the compact medical association,when the number of newly diagnosed patients in tertiary hospitals is certain,there must be an optimal down-conversion rate to maximize the expected benefits of the system;When the number of newly diagnosed patients in tertiary hospitals is uncertain,the maximum expected return function of the system exists only when the down-turn rate meets certain conditions.(2)In the compact medical association,whether the number of patients in tertiary hospitals is determined or not,when the proportion of mild patients in community hospitals and tertiary hospitals decreases,the number of severe patients increases and the expected benefits of the system increase.Then,the situation of loose medical association,i.e.decentralized decision-making is analyzed,and the referral reward scheme is introduced to explore whether it can realize the coordination of the internal medical service system of loose medical association.The results show that:(1)In the loose medical association,the referral reward scheme cannot achieve the coordination of the two-level medical service system,but the referral reward can increase the expected benefits of the tertiary hospitals and systems,and at the same time improve the transfer rate of tertiary hospitals.Although there is an optimal referral reward scheme to maximize the benefits of community hospitals and achieve a win-win situation among tertiary hospitals,community hospitals and loose medical associations,the value of the optimal referral reward in this community hospital is very small.(2)The more resources available in tertiary hospitals,the greater the optimal benefits of tertiary hospitals;however,counter-intuitively,the less available resources in tertiary hospitals,the greater the optimal benefits of medical associations.The reason is that when the number of available resources in tertiary hospitals is large,the optimal down-conversion rate is relatively small and the idle cost of resources is relatively small,so the optimal income of tertiary hospitals is relatively high at this time;When the number of available resources in tertiary hospitals is small,the optimal down-conversion rate of the system is relatively large,which also leads to low idle cost of resources,so the optimal benefits of the medical service system are relatively high at this time.This explains the fact that the tertiary hospitals in the loose medical association are unwilling to transfer too many patients.The excessive number of patients transferred will lead to higher idle cost of resources and lower the expected benefits of tertiary hospitals.