Research On Tiered Medical Care System Considering Patients’ Healthcare Service Choice

Developing a high-quality,high-efficiency,high-accessibility and low-cost medical care system have recently gained increasing attention for two reasons: the rapid increase in health care expenditures and the simultaneous growth of demand for patients’ expected high-quality health services all around the world.China faces major challenges in transformation of its underperforming disorderly medical treatment and unreasonable medical resources allocation,fragmented system into one that delivers high-quality and efficient care to meet the emerging health needs and rising patient expectations associated with demographic changes,environmental pollution,disease spectrum changes.In this thesis,we aim to develop a tiered medical care system of " family physician – secondary and tertiary hospital – high level hospital" according to quantitative analysis of patients’ healthcare service choice.Firstly,we develop a medical institution service usage model considering the patients’ healthcare service choice,where the choice is defined by quantifying severity of illness,age,education degree,monthly per capital disposable income,the outpatient price and service capacity.We also make a comparison of statistical data to simulation results of patients distribution.This conclusion predicts that primary health care system of close and reliable "agency mechanism" with patients,combined with secondary-tertiary hospital medical system of continuously medical service quality promotion might be an efficient alternative pathway.Secondly,we propose a family physician signing model of "service standardization" and "calibration of contracted population".Then we construct the evolutionary game between the willingness of contracted population and the work enthusiasm of the family physician.Through the fitness analysis of evolutionary game,suggestions are provided as follow:(1)enhancing the enthusiasm of signing the family physician;(2)reducing the cost of basic medical service provided by family physician;(3)improving bonus given of effective signing and increasing penalties of not ideal health management;(4)enhancing the signing of special group.Thirdly,we propose a secondary-tertiary hospital service model for patients in the certain area of "Assumption of Health Responsibility".Then we establish the evolutionary game between patient’s medical choice in secondary-tertiary hospital and doctor’s cooperative treatment.Through the fitness analysis of evolutionary game,suggestions are provided as follow:(1)strengthening disease prevention of patients with difficultcomplicated case;(2)enhancing secondary hospital’s structural adjustment and transformation for high-quality;(3)improving income compensation of tertiary hospital doctor’s cooperative treatment.Finally,we recommend "high level hospital referral platform" for the matching between the demander and supplier of high level hospital medical service on the Internet.We also provide an example simulation of matching model above and verify the theoretical feasibility of the matching model.Through the discussion of realistic limitations,suggestions are provided as follow:(1)promoting the information computation research of professional medical service;(2)strengthening the information security of medical care system.We study the instance of tiered medical care system in Xingtai Ninth Hospital at the end of this thesis.Through the analysis of tiered medical care system,suggestions are provided as follow:(1)expanding the talent ranks of primary medical care;(2)improving the primary medical care technique level;(3)promoting the medical care homogenization management between primary institution and secondary-tertiary hospital;(4)enhancing secondary hospital’s structural adjustment and transformation for high-quality;(5)establishing the medical cloud platform between secondary-tertiary and high level hospital;(6)highlighting the technical advantages of diagnosis and treatment in high level hospital.