Research On Optimal Allocation Of Medical Resources In The Community Hospital Under The Hierarchical Healthcare System

As our country enters a population aging society gradually,the people's demand for medical services and resources is increasing.“Seeing a doctor is difficult and expensive” is still a problem that affects the government,the medical institutions and the patients.Although China continues to implement the new medical reform system,the problem of “Seeing a doctor is difficult and expensive” still needs to be solved.The medical service system in China still faces the problem of uneven distribution of medical resources and low utilization efficiency.According to the experience of international developed countries,the hierarchical healthcare system is an effective way to solve the problem of medical resource allocation.China began to implement the hierarchical healthcare system in 2006,and it has been more than ten years.However,the implementation effect is far from expected.In Chinese current hierarchical healthcare system,high-quality medical resources are mainly concentrated in large hospitals.Expensive medical resources in large hospitals are often wasted on the treatment of common diseases,while the service capabilities of community hospitals are mostly idle.The reason is that because of the special nature of medical services,the influence of the behavioral characteristics of patients and medical staff on the operation of the hierarchical healthcare system is very complicated.Therefore,the influence mechanism of the behavioral characteristics of patients and medical staff on Chinese hierarchical healthcare system design and operation strategy needs to be studied.Based on the analysis of the background and current situation of Chinese medical service system,this paper aims to address the issues of uneven distribution of medical resources,mismatch between supply and demand,and inefficient utilization of medical resources.It is proposed to study the optimal allocation of medical resources under the hierarchical healthcare system from the perspective of behavioral operations.This article studies the behavioral characteristics of patients,considers patients with delay-sensitivity,constructs the patient's utility function,uses the queuing theory to describe the patient's choice of hospital treatment process,and establishes a corresponding mathematical model.Under the goal of minimizing the total social cost,through the study of the resource allocation strategies of community hospitals under the free referral system and the gatekeeper system,we obtained the strategies for optimal resource allocation.The study found that: the optimal resource allocation strategy of community hospitals depends on the total patient arrival rate,the service capacity of large hospitals,and other exogenous parameters.When the service capacity and total patient arrival rate of large hospitals are in different situations,the optimal resource allocation strategy of the medical system will result in three situations: operate only in community hospitals,operate only in large hospitals,and the gatekeeper system which operate simultaneously in community hospitals and large hospitals.By comparing the free referral system with the gatekeeper system,it is found that the total social cost under the gatekeeper system is always no greater than the total social cost under the free referral system.Because the behavior of patient's choice produces negative externalities,the gatekeeper system is superior to the free referral system.The subsidy mechanism and priority mechanism can effectively regulate the behavior of patients,regulate the flow of patients,and achieve the same optimal state as the gatekeeper system in the free referral system.In real life,the government can regulate the behavior of patients by improving the medical insurance system and family doctor signing services as well as the medical association model to achieve a scientific and rational allocation of medical resources under Chinese hierarchical healthcare system.We obtained some general conclusions through the study of the optimal allocation of medical resources in community hospitals under the hierarchical healthcare system.And they could be applied in the optimization of other hierarchical service systems to solve the problem of congestion and resource allocation in multi-level service systems.