Game Research On The Strategy Choice Of Stakeholders Under The Dual Referral System

With the increasing contradiction between the demand for medical services and the development of medical services,the government has actively implemented the hierarchical diagnosis and treatment pattern of "First diagnosis at the primary health care institutions,Dual referral,Differentiation of acute and chronic,and Linkage between upper and lower levels.Among them,the dual referral system is the key to the orderly establishment of a hierarchical diagnosis and treatment pattern.The effective implementation of the dual referral system is essential for building a reasonable medical situation,improving the overall cooperation service efficiency of the medical system,and realizing the sustainable development of the medical system.It has great theoretical significance and practical value.Based on the analysis of the current dual referral system background,related theories and research status,this study discusses the stakeholders involved in the dual referral system and their game relationships.First,analyze the game relationship between two-level medical institutions under the dual referral system;then add patients to explore the game relationship between patients and medical institutions;finally add the government to analyze the game relationship between the government,patients,and two-level medical institutions.Analyze the stakeholders involved in the dual referral system and their game relationships,then based on each stakeholder making the optimal strategy in the game,this paper discusses the income distribution mechanism in the dual referral system,the incentive conditions for the implementation of the dual referral system,the medical choice of patients and the choice of government supervision strategies.First,starting from the medical supplier,based on the perspectives of the two stakeholders of the upper and lower medical institutions,a game analysis is carried out on the referral cooperation relationship and income distribution between them.By constructing a competitive game model and a cooperative game model of two-level medical institutions,the research compares the utility of two-level medical institutions in the two game models.The study found that the formation of a referral cooperative alliance between two-level medical institutions can obtain more benefits.Then,the K-S solution is used to construct the income distribution mechanism of two-level medical institutions,which provides a fair decision-making basis for the income distribution of upper and lower medical institutions in the dual referral system.Secondly,combined with the medical demand side,add the patient as a stakeholder based on the above two stakeholders,and conduct a game analysis on the incentive conditions for the implementation of the dual referral system institutions and the medical choice of patients with heterogeneous conditions.By constructing a dynamic game model between medical institutions and patients in the dual referral.Using the inverse solution method to quantitatively analyze the game equilibrium solution of the medical choice of patients with heterogeneous conditions,the purpose of guiding patients to “primary care”and “primary rehabilitation”.Then analyze the incentive conditions for the implementation of dual referral strategy in different situations from the perspective of decentralized and centralized decision-making.The study found that the implementation of the dual referral strategy can guide patients to choose primary care and rehabilitation,then found that the willingness of patients to choose primary medical institutions can be improved by appropriately reducing pricing,expanding the difference between the reimbursement ratios of two-level medical institutions,and improving primary service capabilities.At the same time,the study pointed out that through the appropriate planning of the primary health care institutions service capacity,medical institutions can be encouraged to choose the strategy of implementing the dual referral system.Finally,introduce the government as a macro-regulator to discuss the game relationship among the four stakeholders of the government,higher-level medical institutions,primary medical institutions and patients in the dual referral system.It also conducts game analysis on the strategy choice of government supervision,the strategy choice of higher-level medical institutions implementing the dual referral,the strategy choice of lower-level medical institutions implementing the dual referral,and the strategy medical choice of patients.According to the game payout matrix,the evolutionary game model of the participation of the four parties is constructed from the micro level,and the dynamic evolution path,the evolution law,and the equilibrium solution of the strategy combination of the four parties’ strategic behavior are analyzed by copying the dynamic equation.The study found that the government’s financial appropriation is the determinant of the evolution of the government’s supervision strategy.The increase of the probability of government supervision will increase the willingness of higher-level medical institutions to implement the dual referral,and the probability of primary medical institutions to cooperate with the implementation of the dual referral system will also increase.At the same time,with the increase in the number of higher-level medical institutions and primary medical institutions that choose to implement the dual referral system,patients are also willing to seek medical treatment at the primary medical institutions.This provides a theoretical basis for accurately grasping the logic of interest generation among participants in the dual referral system and the evolution mechanism of the strategies of all parties.Whether the dual referral system is effectively implemented is directly related to the formation of an orderly medical treatment situation and the effectiveness of the new medical reform.As stakeholders in the implementation of the dual referral system,the policy choices of the government,medical institutions and patients all have an impact on the dual referral system.Therefore,it is necessary to conduct relevant basic theoretical research on the strategic choices of stakeholders in the dual referral system.