Research On The Least Cumulative Resistance Model Of Inpatient Reasonable Selection Of Medical Institutions For Rural Residents Based On Prospect Theory

[Purpose]This project based on the demand side perspective,analyze the psychological behavior characteristics of rural residents in the hospital medical institutions to choose,defines the rationality of the rural residents in the hospital flow,and explore different internal and external environment factors on the impact mechanism of rural residents in the hospital to clear based on prospect theory of different risk attitude and reference point change law of rural residents,Based on the analysis of the rationality of rural residents' hospitalization flow from the micro perspective,and based on the systematic analysis,the minimum cumulative resistance model of rural residents' rational hospitalization flow is constructed,which provides support for enriching the "limited rationality" decision-making process of rural residents' hospitalization flow and facilitating the precise implementation and promotion of policies.[Methods](1)Literature research: Retrieve relevant domestic and foreign literature based on keywords.Through literature review and analysis,systematically sort out domestic and foreign related rural residents' hospitalization triage,referral mechanisms and influencing factors,rural residents' medical behavior,prospect theory,multi-attribute decision-making methods,health ecology models,system analysis ideas,and least cumulative resistance models The progress in policy resistance has laid a scientific basis for this research,and supplemented the necessity of this research,and analyzed the applicability of related theories in this research.(2)Theoretical analysis: use prospect theory to analyze the psychological and behavioral characteristics of rural residents' choice of inpatient institutions,confirm the applicability of prospect theory in this research;use health equity theory,social division of labor theory,incentive compatibility theory,and combine healthy China strategy and classification The diagnosis and treatment system puts forward the principles and standards for defining the rationality of rural residents' hospitalization flow;using health ecology theory,Anderson health service utilization behavior theory and complex system theory,analyzes the mechanism of internal and external environments affecting the flow of rural residents' hospitalization,and proposes rural residents' hospitalization The model of the mechanism of flow influencing factors.(3)Empirical analysis: use logistic regression model to initially analyze the factors that affect the selection of rural residents' hospitalization institutions;at the same time,set up scenario simulation experiments for the hospitalization selection process,use gradient descent algorithm to estimate rural residents' risk attitudes;use generalized linear models and orderly Multi-class logistic regression analyzes the change rule of the reference point of rural residents' hospitalization flow;uses the mixed multi-attribute decision-making method to judge the rationality of rural residents' hospitalization flow;finally,uses the Bayesian structural equation model to construct the minimum cumulative resistance model of the rural residents' hospitalization flow.To formulate key intervention targets for the rational flow of rural residents in hospitals.[Results](1)Through the analysis of the national health statistics data and the national health service survey data,it is found that with the gradual improvement of the new rural cooperative medical care level in China,the proportion of rural residents' first diagnosis in the primary medical institutions in the survey area is gradually decreasing,while the proportion of first diagnosis in the county level and above medical institutions is increasing.After 2008,the inpatient proportion of rural residents in primary medical institutions gradually decreased,and the market share of township health centers showed a shrinking trend,while the inpatient proportion in county-level and above hospitals showed an increasing trend,indicating that the inpatient flow of rural residents was not reasonable.(2)Preliminary analysis of factors affecting the choice of rural residents' inpatient medical institutions.The results of multi-factor analysis show that rural residents choose towns under the conditions of income grouping,hospitalization experience in county hospitals in the past year,disease cognition bias,and the sinking of county-level doctors.The four indicators of the possibility of health centers have a significant impact on the rational flow of rural residents in hospitals.(3)The risk attitude analysis results show that there are some common characteristics among different types of rural residents.Specifically,the loss avoidance coefficient of all rural residents for the probability of disease cure is much greater than 1,and basically remains at about 10,indicating that all rural residents All show a large degree of loss aversion,but the degree of aversion between different categories is quite different;at the same time,the sum of all types of rural residents is between 0 and 1,which also proves that all rural residents face The gains and losses are risk aversion and risk pursuit respectively.(4)The results of multi-attribute decision-making show that(1)The higher mean probability of disease cure is related to the characteristics of rural residents' hospitalization experience and greater deviation in disease cognition without county hospitals.There is a small gap in the maximum out-of-pocket medical expenses of different income groups.With the increase in income,the reference point of the highest out-of-pocket medical expenses for rural residents has risen slightly.(2)The average value of the attribute is significantly higher than the weight of other attributes,basically stable between 0.57-0.69,while the weight of other attributes is basically stable at about 0.10,the four attributes of different types of rural residents have very little difference,indicating that the average weight is possessed by rural residents Wide applicability;(3)The overall parameters have strong versatility in different diseases or different types of rural residents.The category parameters from C1 to C14 and the overall parameters show an upward trend as a whole,which indicates that as income levels increase,it may have a more significant impact on the irrational flow of hospitalization.(5)The analysis results of the minimum cumulative resistance model show that the parameters of the model meet the convergence standard,and the model estimation results are good.Finally,based on the definition of the concept of "resistance" and the transmission path,we construct the least cumulative resistance model.According to the influence effect and direction of the structural model and the measurement model,we draw up from the point of view of policy control objectives and controllability,this research Preliminarily obtained the policy environment ? ? Residents' experience ? ? Disease cognitive bias ? ? Reasonable hospitalization flow ? is the least cumulative resistance model based on the reasonable flow of rural residents in hospitalization under the scenario of this research.At the same time,this research also concludes that the reasonable flow of hospitalization can be reduced The suboptimal path of resistance is the policy environment?? accessibility?? disease cognitive bias?? rational flow of hospitalization?.[Conclusions]Rural residents is hospital institutional choice decisions of micro main body,from macro to micro level is the minimum cumulative resistance model,and the rational flow of hospital performance is from the perspective of policy,by improving the basic-level hospital feeling of the rural residents,correct the rural residents disease cognitive biases,ultimately achieve the goal of the rational flow of hospital.At the key nodes of the minimum cumulative resistance model of rational flow of hospitalization,it is mainly influenced by multiple systemic resistance factors from government departments,medical insurance departments,medical institutions,medical personnel and rural residents themselves,and there is mutual influence among the resistance factors.In order to promote the rational flow of hospitalization of rural residents,this study suggests:(1)optimizing resource allocation: ensuring that resource input is in line with the orientation of institution development;(2)Strengthen medical insurance payment: improve the benefit integration mechanism among medical institutions in the county;(3)Grasping the response of the demander: the key link to improve the rationality of rural residents' mobility.[Innovation and Deficiency]The innovations of this research are as follows:(1)Research perspective innovation: This research is closely related to the hospitalization flow of key target groups in the process of medical reform,and uses the systemic resistance in the process of micro-subject mobility as a research perspective to make up for the lack of micro-subject behavior and system thinking in the current research perspective.Missing.The output of the research will provide scientific solutions to solve the current insufficient guidance of micro-subjects and the continued existence of flow problems;(2)Theoretical innovation: This study introduces prospect theory and system analysis into the design of the rational flow of rural residents in hospitalization,and integrates the psychological behavior of micro-subjects into the research on the flow of hospitalization for the first time.The three elements of prospect theory are analyzed and combined with micro individuals Local actual judgement of rationality;(3)Methodological innovation: This research is the first time that prospect theory risk attitude estimation and multi-attribute decision-making technology are introduced into the prediction research of medical behavior decision-making,and the gradient descent algorithm is applied to risk attitude estimation for the first time,and the results include prospect theory A series of results such as risk attitude parameter estimation,reference point dynamic change law,multi-attribute decision-making results,and minimum cumulative resistance model have good generalization and operability.The shortcomings of this study are as follows:(1)Policy analysis,literature research and theoretical analysis were mainly adopted in the definition of the rationality of rural residents' hospitalization mobility,and the results of expert consultation were lacking,which should be supplemented in the follow-up research;(2)In the process of simulating and measuring the cure probability and actual probability of diseases designated by county and township medical institutions in the research area,there are many weaknesses in the control of probability accuracy,and there is still a large room for improvement in the method of probability estimation of field research data.(3)The real world is complex,so is the psychological behavior of decision makers.The multi-attribute decision analysis method proposed in this paper still cannot fully consider the psychological behavior characteristics of all rural residents' hospitalization flow,but mainly considers the psychological behavior of decision makers,such as reference dependence,loss avoidance,and decreasing sensitivity.In order to make the proposed decision-making method reflect the actual decision-making behavior of the decision-maker,it needs to be further studied.(4)This study is mainly based on the quantitative results of the minimum cumulative resistance model,that is,based on the compensation change,sinking and remote diagnosis and treatment of the perception of service,disease cognitive bias,and finally settled to the rational flow of hospitalization,and then mainly discusses the relevant policy level,but still lacks strong data support.More quantifiable policy,institutional and individual elements should be incorporated into research in the future.