基于系统动力学理论的分级诊疗服务模型研究

Hierarchical medical system is the social public welfare undertakings, belongs to the category of public management. Establishing hierarchical diagnosis system, which is the important measures to rational allocation of medical resources and promote the equal basic medical and health services .The Chinese healthcare system reform is committed to explore the ways of healthcare medical care system construction; however, the ordered medical care process has not been established yet. The reforms need evidence from scientific research, and the evidence for a policy to be optimized. The health system is a dynamic and complex social system. it is necessary to carry out comprehensive and dynamic analysis of the system from multiple perspectives. In view of this, the study introduce system dynamics model and the innovative network analysis method, to simulate the influences of resources allocation, health care institution’s service capability, health care institution’s innovative network, health insurance and patient’s medical care seeking behavior, to compare the advantages of each scheme, predict and optimize the intervention strategy. First of all, Focusing on the real process of graded diagnosis and treatment to formulate key targets for policy optimization; secondly, Building the dynamic model of hierarchical medical service system, the key targets are simulated and verified according to the real data; finally, The advantages of the adjustment scheme of different hierarchical medical service models are compared and analyzed by simulation, determining the optimal intervention strategy by empirical study.

分级诊疗服务体系是社会公益事业，属于卫生政策与体制改革的范畴。建立健全分级诊疗体系是合理配置医疗资源、促进基本医疗卫生服务均等化的重要举措。虽然医改对分级诊疗服务体系进行了诸多探索，但目前有序分级诊疗秩序尚未形成，改革需要来自科学研究的证据支持、优化政策方案的证据。由于卫生系统是动态复杂的社会系统，因此有必要从多角度对系统进行综合性、动态分析。鉴于此，本研究引入系统动力学模型及创新网络分析方法，通过模拟仿真对资源配置、医疗机构服务能力、医疗机构间创新网络合作度、患者就医行为、医保政策等多个核心因素进行动态的综合分析，比较各方案优势，预测并优化干预策略。首先，围绕分级诊疗真实过程进行焦点问题分析，拟定政策优化的关键靶点；其次，构建分级诊疗服务系统动力学模型，依据现实数据对关键靶点进行仿真验证；最后，基于仿真验证比较分析不同分级诊疗服务模型调整方案的优势，确定优化干预策略并举例实证。

我国现有医疗卫生服务体系呈现“不合理布局”、“分散式结构”和“疾病负担加重”等现象，建立健全分级诊疗体系是合理配置医疗资源、促进基本医疗卫生服务均等化的重要举措。虽然医改对分级诊疗服务体系进行了诸多探索，但目前有序分级诊疗秩序尚未形成，改革需要来自科学研究的证据支持、优化政策方案的证据。由于卫生系统是动态复杂的社会系统，因此有必要从多角度对系统进行综合性、动态分析。鉴于此，本研究引入系统动力学模型及创新网络分析方法，，围绕分级诊疗真实过程进行焦点问题分析，拟定政策优化的关键靶点，构建分级诊疗服务系统动力学模型，依据现实数据对关键靶点进行仿真验证。首先，本研究对相关行政部门负责人、医疗卫生机构负责人和其他关键知情人及利益方进行访谈，主要访谈其对分级诊疗的认知、政策理解、运行模式、转诊流程规范、外部监管与信息反馈等方面，并做了基线调查。其次，项目组利用利益相关者理论、社会分工理论、供应链理论、创新网络理论等方法和理论，分析分级诊疗服务模式结构及逻辑关系，明确了关联主体及各个因素的相关关系，构建主函数并对部分样本地区进行政策干预模型仿真。从而揭示了系统结构问题及其相互作用机制，对提高分级诊疗服务模式服务效率、推动患者有序就医和降低医疗费用等方面具有正向作用，为推动医疗服务市场健康有序发展提供理论和事实依据，以期为完善地方政府分级诊疗服务体系提供参考。