Research On Patients' Health Seeking Behavior And Institution Selection Under The Hierarchical Health Care Delivery System

In recent years,people's living standards have been continuously improved and their health needs have been growing.However,the problems of insufficient health resources,unreasonable structure and weak grassroots service capacity in China are still outstanding.Hierarchical health care delivery system has become an important measure for the country to deepen the reform of the medical and health system and promote the equalization of basic medical and health services.The implementation of the hierarchical health care delivery system is of great significance for promoting the longterm healthy development of the medical and health undertakings,improving the people's health,ensuring and improving people's livelihood.Advancing and improving the hierarchical health care delivery system is the necessary path to achieve a healthy China strategy.The State Council's “13th Five-Year Plan” to deepen the reform of the medical and health system indicates that it is necessary to adhere to the voluntary,primary medical consultation,policy guidance,and innovation mechanisms of the residents,and establish a scientific and rational hierarchical health care delivery system.Although various regions of the country have actively explored various forms of hierarchical health care delivery systems,and promoted the formation of a new order for first visit in primary care institutions,two-way referral,acute disease and chronic disease are treated separately,and primary care institutions and hospitals need linkage,the implementation of hierarchical health care delivery is not obvious,and did not achieve the expected results.The existing research focuses on the improvement of traditional medical service models and the optimization of unbalanced medical resource allocation,and the focus of attention is on the supplier of medical services such as government and hospitals.The health seeking behavior of patients as a key demand subject of medical services in the medical service process is neglected.In view of this,this paper takes the demand side of medical service as the key research object,based on the theory of health seeking behavior and uncertain decision-making,carries out research on the patient's health seeking behavior and institutional selection under the hierarchical health care delivery system.The research has important theoretical and practical value for enriching the health seeking behavior theory and institutional selection method and improving the construction and implementation of the hierarchical health care delivery system.This paper focuses on patients' health seeking behavior and institutional selection under the hierarchical health care delivery system.Based on the review of the existing research about the hierarchical health care delivery system and patient's health seeking behavior,condensed the characteristics of many influencing factors,complex decisionmaking information,and multiple stakeholders in patients' health seeking behavior.Through the empirical analysis,the key influencing factors of patients' health seeking behavior under the hierarchical health care delivery system were studied.A method for personalized medical institution selection for multi-source uncertain information and individual differentiation preferences is proposed.The evolutionary game model of patients' medical institution selection under the participation of multiple stakeholders was constructed and the evolution process was analyzed.The effectiveness of the proposed model is verified by case studies and simulations.The main contributions and innovations are demonstrated as follows.(1)The impact mechanism analysis of patients' health seeking behavior under the hierarchical health care delivery system.Based on the theory of planned behavior and the Anderson health care utilization model,the study constructed a patient medical treatment intentional influence model.Based on this model,a questionnaire for measuring the influencing factors of patients' health care seeking behavior was designed,and data was collected through online questionnaire survey.On the basis of the questionnaire and the model passed the test,the structural equation model was constructed to explore and analyze the intention of first visit in primary care institutions and first visit in hospitals.It reveals the influence mechanism of different influencing factors on the intention of first visit in primary care institutions and first visit in hospitals.To provide guidance for patients to choose primary care institutions at first and to reasonable choose medical institutions.(2)The medical institution selection for individual patient under uncertain information and differentiated preferences.This paper analyzes the choice of medical institutions,and designs a decision-making framework for patients' medical institutions in the Internet according to the behavior characteristics under the hierarchical health care delivery system and Internet environment.Based on the decision-making framework,the spatial construction of individual decision-making criteria,information sources and its diverse expressions are described.New weighting rules are introduced to describe the differentiated preferences of individual patients.An improved SMAA method is proposed.The method is used to generate a complete ranking of the alternatives.By collecting hospital statistics,third-party evaluations and personal patient information in the real-world,we demonstrate the effectiveness of the proposed approach.(3)The evolution analysis of patient population medical institution selection with the participation of multiple stakeholders.The research analyzes the relevant stakeholders in the medical service system under the hierarchical health care delivery system,and constructs the evolutionary game model between the key participating hospitals and patients.The game strategy and payoff matrix between hospitals and patients are designed,and the evolutionary stable strategy and stability of both sides of the game are analyzed.Used Matlab to simulate the evolutionary game model,and the initial parameters were set according to the existing hierarchical health care delivery system.By adjusting different parameters,this experiment explored the impact of key factors such as the initial proportion of strategy selection,government financial support,hospital implementation cost and patient and hospital income on the evolution of patient and hospital strategy selection.And some suggestions for improving the hierarchical health care delivery system are proposed.In summary,how to guide patients to scientifically and rationally choose medical institutions and ensure the orderly flow of patients in the medical service system is an important breakthrough for the full realization of the hierarchical health care delivery system.This paper reveals the influence mechanism of patients' health seeking behavior from the perspective of patients' medical service demand side,and proposes a method for individual patient medical institution selection,and explores the strategic selection process that affect patient population medical institution selection.It provides an important reference for establishing a scientific and rational hierarchical health care delivery system.It is worth noting that in order to ensure the sustainable development of medical and health care,the promotion and improvement of scientific decisionmaking methods are a new challenge.At the same time,with the continuous deepening of Internet services and the rapid advancement of artificial intelligence,multi-source and multi-modal data such as text,images and video have grown exponentially.How to provide personalized and accurate medical services for patients by acquiring,processing and integrating multi-source multi-modal massive data will become an important research direction in the future.