ABSTRACT
The hierarchical diagnosis and treatment system is an important measure for rational allocation of medical resources, promotion of equalization of basic medical services, improving the patients' disorderly medical treatment and guiding patients' hospital choice behavior. This paper defines the utility function of rational medical treatment of patients affected by multiple factors such as the personal disposable income,the age,the severity of the self-induced illness and the decision-makers' education level, and considered the outpatient price, service capacity and other factors of medical institutions. The present study constructed the incomplete information dynamic game model based on fictitious play method. It provided the quantitative analysis of the statistical data of Qinhuangdao and obtained the patients distribution in medical institution. The rationality of the model was verified by comparing the simulation with actual data,and showed the choice is more reasonable between the primary health care and general hospital. Therefore,the emphasis of optimizing the medical service resources in hierarchical diagnosis and treatment system is to establish the treatment system of integrated medical service for patients'on-demand and on-demand medi-cal services. At the same,various incentives should be used to enhance patients'enthusiasm for primary health care.
ABSTRACT
The paper analyzed the decision-making process of the doctor's treatment and patient's decision-making. Then established the evolutionary game model of patient's and the secondary-tertiary hospital doctor's strate-gy. The Matlab simulation software were used to analyze the influencing factors of patient-doctor strategy-making sys-tem. We proposed the advice reducing critical patient's utility loss diagnosed in secondary hospital,improving medi-cal experience of common patient in secondary hospital,strengthening disease prevention of critical patient,and pro-moting labor division and cooperation between secondary and tertiary hospital to make result develop towards reduction the disorderly,chaotic and dislocated medical need and an integrated secondary and tertiary system.
ABSTRACT
Objective:To understand the impact of hierarchical medical system on the medical staff at all levels of medical institutions in the pilot areas,and their cognitive status and influencing factors for hierarchical medical sys-tem,for the purpose of providing scientific reference for improving the hierarchical medical system. Methods:435 of medical staffs were selected with the help of by stratified random sampling from different levels of medical institutions from 15 pilot areas and a questionnaire survey methodology was used in this study to gather views of the medical staffs. Results:It has been revealed that after the system is implemented,there were differences in the total monthly salary,performance pay ratio,workload and the relationship between doctors and patients at different levels of medi-cal institutions. The medical staff at all levels of medical institutions had a high degree of awareness of hierarchical medical system,and the cognition rate was 81.4%. Among them,tertiary hospitals,township hospitals,community health service centers,secondary hospitals;different department categories,job titles,performance pay ratio and sal-ary changes in the medical staff have different cognition of the grading. Conclusions:To further develop the key role of medical staff in the hierarchical medical system, strengthen the attention of secondary hospitals to enhance the service capacity of primary healthcare units at the same time,reform the pay system,mobilize the enthusiasm of med-ical institutions and medical staff,and promote the development of hierarchical treatment system.