Based On Modified Shapley Value Of Member Interests Distribution In Close Medical Alliance Research In China

Medical alliance is an important carrier for the implementation of hierarchical medical system.Since 2009,the state has issued many documents to accelerate the construction of medical alliance.At present,the urgent problem to be solved in the construction of medical alliance is to construct the benefit distribution mechanism of medical alliance members.The development of Chinese medical alliance has roughly gone through four stages: the embryonic stage(1980s-mid-1990s),the exploratory stage(1990s-mid-1990s--2009),the formal pilot stage(2009-2017),and the comprehensive promotion stage(2017-present).At present,the medical alliance according to the close degree between each member can be divided into the close medical alliance and the loose half close medical alliance and the loose medical alliance of three categories,including close medical alliance because there are a lot of people,goods,all aspects of the highly integrated,best in three kinds of couplet of medical effect,less loose medical couplet body due to the integration of resources,establish the difficulty is relatively small,most care of couplet choosing component types tend to loose.In the analysis of the current situation and existing problems of the distribution of medical alliance interests in China,this paper divides the stakeholders of medical alliance into government agencies,medical institutions and individuals according to the hierarchy.The government agencies are mainly the departments closely related to the interests of medical alliance,such as health committees at all levels,finance and medical insurance.Medical institutions mainly include core hospitals and other medical institutions participating in the construction,which are the core stakeholders of medical alliance.The current situation and problems of medical alliance interest distribution in China are as follows: 1.The finance and health insurance did not regard the medical alliance as an alliance to make government payment,so that the members of the medical alliance block2.Members,especially core hospitals and primary medical institutions,have a fierce game;3.The government does not fully adjust the interests of medical association,and the medical community has not established a clear benefit distribution mechanism.In the case study,this paper selects the Shapley value method model to construct the medical alliance benefit distribution model.In terms of index selection,combining with literature materials and expert opinions,the indexes of the modified Shapley value method model were determined to be the input degree of each member,the amount of up and down referral,and the management cost.The analytic hierarchy process(AHP)was used to calculate the index weight,and the classical Shapley value model was modified.By comparing the Shapley value model before and after the revision,it can be found that after the revision,the proportion of benefit distribution in core hospitals increases,the proportion of benefit distribution in secondary hospitals and primary medical institutions decreases,and the proportion of benefit distribution in primary medical institutions decreases significantly.In view of this result,this paper puts forward that it is necessary to ensure the reasonable income of primary medical institutions,the input cost of core hospitals should not be transferred to primary medical institutions and secondary hospitals,and the government should give subsidies to ensure that members have a high enthusiasm,so as to make the medical alliance sustainable and healthy development,and achieve the goal of strengthening the grassroots.