The Promotion Strategy Of Cooperation Between Central Hospitals And Primary Medical Institutions In Medical Consortium From The Perspective Of Multi-agent Game

In order to solve the uneven distribution of quality medical resources between hospitals and primary medical and health institutions,and to alleviate the problem of overcrowding in large hospitals and too few patients in small hospitals to a certain extent,our state put forward the medical cooperation model of medical association to promote the rational distribution of medical resources.But from a practical point of view,as a result of the undirected guidance of government policy,the lack of incentive mechanism,the insufficient support from the core hospital and the doctors,the lack of confidence of the patients to the primary medical and health institutions,the current operation process of the medical core hospital and the primary medical and health institutions is not smooth,running the key point which resists the operation of the medical consortium.Therefore,by means of multi-stage game,efficiency analysis,principal-agent theory,multi-criteria decision making and other methods and tools,a research has been made on the cooperation mechanism between the center hospitals and primary medical and health institutions in this dissertation.1.From the perspective of multi-subject game,an integrated research and analysis framework is established to promote the cooperation between central hospital and primary medical institutions.The stakeholders of the medical consortium are studied and the benefits and risks of each major stakeholder are analyzed.On this basis,the analysis framework is elaborated from three aspects: the cooperation between the central hospital and the primary medical institutions,the market conflict between the central hospital and the primary medical institutions,and the micro basis of the cooperation and competition between the central hospital and the primary medical institutions.Then,the current situation and key influencing factors of the cooperative game between the central hospital and the primary medical institutions are studied.Under the framework of analysis,three scientific management problems are revealed to promote the cooperative strategy between the central hospital and the primary medical institutions in the medical union,respectively are the choice of support behavior of central hospital under government subsidy;the patient's choice of medical treatment under the medical insurance system;the incentive strategy of hospital to the doctors,which has laid an important foundation for the study.2.The three problems under the research framework are discussed respectively,and the main research contents and conclusions are as follows.(1)In order to promote the support behavior of central hospital,the problem of government subsidy and the behavior choice of central hospital are studied.The main research objects of the model are the government,the central hospital which takes the active support strategy and takes the passive support strategy,a three stages game model is established,and the coefficient of government subsidies,the degree of support of the center hospital,the quantity and price provided by the two kinds of central hospitals services are studied,then the backward induction method is used to solve the model,and numerical simulation methods are used to analyze the influence of related parameters on the results of the model.The results show that:(1)There is a positive relationship between patients' demand for high-quality medical services and the coefficient of government subsidies;(2)There is an inverse relationship between patients' demand for high-quality medical services and the degree of support provided by the central hospital adopting the passive support strategy,while there is a positive relationship between the degree of help provided by the central hospital adopting the active support strategy;(3)With the increase of the lower limit of the degree of government subsidy,the degree of the central hospital that adopts the negative strategy is decreasing,while the degree of the central hospital that adopts the positive strategy is increasing.(2)In order to alleviate the market conflict between the central hospital and the primary medical institutions,the problem of medical insurance subsidy guiding patients to choose medical institutions is studied.Based on the consideration of patients' medical care preferences and medical insurance reimbursement expenses,a three-stage game model is established among medical insurance departments,hospitals and patients,and the optimal reimbursement ratio of medical services provided by central hospitals and primary medical institutions is solved,the relationship between the optimal reimbursement ratio coefficient and other variables is directly reflected through an example analysis.In particular,the influence of patients' sensitivity to medical quality and medical cost on the reimbursement ratio coefficient of medical insurance is discussed.The results show that:(1)With the increase of patients' sensitivity to medical quality,the optimal subsidy coefficient of medical insurance for patients receiving medical treatment in central hospitals is decreasing,while the subsidy coefficient of medical insurance for patients receiving medical treatment in primary medical institutions is increasing;(2)With the increase of patients' sensitivity to medical price,the optimal coefficient of medical insurance subsidy for patients who go to hospital in both medical institutions increases,and the increase of the coefficient of medical subsidy for primary medical institutions is larger than that for central hospitals.(3)The micro-foundation of the cooperation between the central hospital and primary medical institutions--the motivation of doctors' support is studied.The doctors' efforts,ability,material and immaterial incentive coefficients are taken into account,and a combined incentive model of doctors based on the principal-agent theory is established.Further,the expression of dual hesitation fuzzy information and distance measure of different combination incentive schemes is studied,and then an improved TOPSIS method is put forward to sort the specific schemes of doctor incentive schemes,so as to provide a basis for proposing more specific and effective incentive schemes.The results show that:(1)Under the condition of ensuring the optimal efforts of doctors,the non-material incentive has a substitution effect on the material incentive;(2)With the increase of immaterial motivation,the optimal effort level increases,and the marginal effort level increases;(3)The effect of immaterial motivation on the motivation of doctors with lower ability or higher ability is more significant;(4)The improved TOPSIS method based on the fuzzy set measure of dual hesitation can deal with the doctors' hesitation and uncertainty about the choice between different incentive schemes,and can provide an effective method for the sorting among different incentive schemes.3.Based on the above research results,the countermeasures and suggestions to strengthen the cooperation between the central hospital and the primary medical and health institutions are put forward.(1)In order to encourage the central hospital to help the primary medical institutions,it is suggested that the medical management department should give the central hospital necessary extra subsidies.The medical insurance management department should appropriately adjust the difference in medical insurance subsidies and service prices between the central hospital and the primary medical institutions;(2)A scientific interest coordination mechanism should be established between the central hospital and the primary medical institutions;(3)The central hospital should formulate the corresponding combination incentive scheme according to the doctors' efforts and abilities;(4)In the cooperation of medical consortium,the service quality of primary medical institutions should be constantly improved,and patients' willingness to choose primary medical institutions could be improved;(5)In the cooperation of medical consortium,the service quality of primary medical institutions should be constantly improved,and patients' willingness to choose primary medical institutions could be improved.To further clarify the division of labor and cooperation among medical institutions,integrate and optimize the superior resources of medical consortium,and lay a foundation for the study of compact medical consortium.The game theory and method is applied to the field of medical management,which expands the application scope of management science,and provides a new theoretical basis,research framework and implementation method for promoting the cooperation among medical institutions in the medical union.It provides a theoretical basis for the management decisions of medical management institutions,medical insurance departments,central hospitals and primary medical institutions.