Research On The Referral Of General Hospital Under The Medical Association

Since 2015,the Chinese government has implemented reforms to establish a hierarchical medical system.However,due to the lack of national laws and regulations on access control,patients are not obligated to follow a specific medical procedure.As a result,large tertiary hospitals suffer from overcrowding and insufficient treatment capacity while small primary hospitals(such as county-level hospitals)struggle with patient shortages.Previous research has suggested that a hierarchical medical system,with reverse referral as its cornerstone,can effectively address these issues.However,inadequate information sharing and insufficient connectivity between medical institutions often impede effective collaboration.Meanwhile,the service quality of primary medical institutions varies greatly,posing challenges to ensuring standardized diagnosis and treatment services for patients who may be hesitant to transfer due to concerns about medical care standards.Therefore,this paper proposes the adoption of a medical alliance model to enhance collaboration between general hospitals and primary healthcare facilities,achieve vertical integration of medical resources,and elevate the diagnostic and treatment capabilities as well as service quality of primary care institutions.At present,more incentives such as payment of referral fees,financial subsidies or medical insurance share are adopted in the medical consortium model,but some hospitals rely too much on referral to gain more income,which leads to the problems of unfair medical services and poor referral efficiency.Therefore,it is necessary to continue to optimize and improve the payment method and resource allocation in the current referral strategy,and explore how to effectively promote reverse referral under the medical association model,so as to improve the efficiency and equity of medical resource allocation.In this paper,two referral strategies are proposed for the actual situation:(1)the primary hospitals pay referral fees to general hospitals when admitting referred patients and,under the guidance of the policy,gradually reduce referral payments or even waive referral fees;(2)General hospitals submerge high-quality medical resources to the primary hospital,and discusses the equilibrium results under the two strategies,the utility values of patients,primary hospitals and society in the medical system,and the performance of the profit indicators of the general hospital.By comparing the optimal referral rates and costs of primary hospital expansion under the three strategies,we have explored which strategy can more effectively enhance the service level of primary hospitals,thereby promoting the implementation of reverse referral.The study shows that:(1)when the service level of primary hospitals is low,the primary medical resource strategy can directly affect the referral decision of patients,and the referral rate of patients is greatly increased.At this time,with a slow increase in patient referral rate,the total utility of primary hospitals always increases.(2)When the service level of primary hospitals is high,it is easier for all patients who meet the referral requirements to be transferred to primary hospitals under the sinking medical resource strategy.At the same time,it is found that the more medical resources are not the better,and there is a proportion related to the service level of primary hospitals.When the service level of primary hospitals can meet the needs of basic patients,the sinking medical resources will make primary hospitals pay additional sinking expenses,resulting in a decrease in the total utility of primary hospitals.(3)When the government subsidizing the referral amount of general hospitals is small,general hospitals will still agree to transfer patients who meet the referral requirements when compared with the payment of referral fees or the exemption of referral fees strategy,reducing the dependence of hospitals and patients on government departments.The authors found the minimum point of expansion cost of primary hospitals under the sinking medical resources strategy is smaller than that under the no-referral strategy,and reduced the dependence of the expansion decision of primary hospitals on receiving referred patients,thus effectively encouraging primary hospitals to improve their service level independently.