| 考虑资源下沉与家庭签约的医联体演化博弈 |
| Evolutionary game of medical association considering resource sinking and family contract |
| 摘要点击 7 全文点击 0 投稿时间：2024-05-16 修订日期：2025-03-28 |
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| 中文关键词 医联体协调；演化博弈；资源下沉；家庭签约；患者感知效用 |
| 英文关键词 medical association coordination; evolutionary game; resource sinking; family contract; patients’ perceived utility |
| 基金项目 国家自然科学基金资助项目（No.72171208）、浙江省自然科学基金重点资助项目（No. LZ24G010001） |
| 作者 | 单位 | 邮编 | | 隆清琦* | 浙江财经大学 | 310018 | | 刘杰鹏 | 浙江财经大学 | |
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| 中文摘要 |
| 建立三级医院资源下沉与社区医院家庭签约的演化博弈模型, 探究双方演化稳定策略对于医联体协调的影响机理. 研究发现, 资源下沉单价、单位拥挤成本、签约单位成本、家庭签约率以及单位政策补贴等因素共同影响博弈系统的演化稳定策略; 家庭签约在减少三级医院拥挤成本的同时会减小资源下沉的概率, 当家庭签约单位成本小于其单位政策补贴时, 资源下沉产生正向溢出效应, 反之则为负向. 通过数值仿真拓展分析演化稳定策略下的患者感知效用. 结果显示, 存在两类服务带来的社区医院患者到达率为某一阈值时, 三级医院下沉资源且社区医院实施签约时患者感知效用最大; 无论是资源下沉还是家庭签约, 先实施比后实施更能减少患者总成本; 家庭签约较资源下沉对患者感知效用提升更为显著. |
| 英文摘要 |
| This paper establishes an evolutionary game model of tertiary hospitals considering resource sinking and community hospitals considering family contract and explores the influence mechanism of both evolutionary stability strategies on the coordination of medical association. This study discovers that the unit price of resource sinking, unit crowding cost, unit cost of family contract, family contract rate and unit policy subsidy all affect the evolutionary stability strategies of the game system. Family contract can reduce the crowding cost of tertiary hospitals and the probability of resource sinking. When the unit cost of family contract is less (higher) than its unit policy subsidy, resource sinking produces a positive (negative) spillover effect on family contract. This paper extensively analyzes patients’ perceived utility under the evolutionary stability strategies by numerical simulations. The analysis results discover that there exists a certain threshold of the patient arrive rate of community hospitals brought by the two types of services and patients perceive the maximum utility under the condition of resources sinking and family contract simultaneously. The early implementation of either resource sinking or family contract can reduce total patient cost more than the other one in the latter. The effect of family contract on patients’ perceived utility is more significant than resource sinking. |
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