分级诊疗背景下医疗服务双渠道供需决策与匹配机制研究

In order to solve the problems of unbalanced distribution and concentration of medical resources, China has begun to implement the hierarchical medical system. However, there are still some problems and difficulties in the practice process of this system, such as insufficient supply of doctors, concentrated demand of patients and mismatch between service supply and demand, which make the implementation results unsatisfactory. With the emergence of online healthcare markets, combination of online healthcare and offline hospital will help to alleviate the mismatch between supply and demand of medical services, which has an important effect on the implementation and improvement of the hierarchical medical system. This proposal will investigate three research issues: 1. Decision-making model of doctor service supply based on dual-channel; 2. Decision-making model of patient service selection based on dual-channel; 3. Matching mechanism of medical service based on dual-channel. From multi-perspectives and multi-levels, this proposal will research the supply and demand decision-making and matching mechanism of dual-channel medical services by using mixed research methods. In theory, this research analyses the supply strategy of doctors’ dual-channel services, reveals the influence mechanism of recommendation information on patients’ service and channel selections, and expands the application of two-sided matching theory to medical service markets. The results of this research will help to improve the efficiency of medical resource allocation, alleviate the shortage of medical resource, and provides practical suggestions for online medical market research and current medical reform in China.

为解决医疗资源分布不均衡等问题，我国已开始推行分级诊疗制度的建设。然而，实践过程中存在的医生供给不足、患者需求集中、服务供需不匹配等难点使得该制度的实施效果并不理想。随着在线医疗市场的兴起，在线平台与线下医院的双渠道结合有助于缓解医疗服务“供需错配”的现象，对分级诊疗制度的实施和改善具有重要的影响和意义。本课题拟从三个子研究展开深入探讨：1.基于双渠道的医生服务供给决策模型；2.基于双渠道的患者服务选择决策模型；3.基于双渠道的医疗服务匹配机制研究。拟运用混合研究方法，从多研究视角和多层面对双渠道医疗服务供需决策和匹配机制进行系统的研究。在理论上，本课题剖析医生双渠道服务供给策略，揭示推荐信息对于患者服务选择和渠道选择的影响机制，拓展双边市场匹配理论在医疗服务市场中的应用。在实践上，本课题将有助于改善医疗资源配置效率、缓解医疗资源紧缺现象，为在线医疗市场研究和我国当前医疗改革提供实践指导。

我国医疗改革正在如火如荼的进行中，双渠道医疗服务模式能否缓解线下医院“看病难，看病贵”的问题仍然未知。为探究此研究问题，本研究通过理论分析提出研究假设，并且收集线上渠道和线下渠道的相关数据构建实证研究模型验证相关的研究假设。首先本研究构建面板向量自回归模型，该模型不仅考虑线上渠道和线下渠道之间的相互作用和影响，还能够探究变量之间不同时期的动态关系。同时控制医生的固定效应，使用广义矩估计方法对模型进行估计用以解决变量之间的内生性问题。研究结果发现在线渠道的患者数量能够直接缓解线下门诊的患者数量。尽管不能直接缓解线下住院患者数量，但是通过脉冲响应分析变量之间的作用机制发现线上渠道患者数量能够间接影响住院患者数量。因此，双渠道医疗服务模式能够缓解线下渠道中“看病难”的问题。并且，本研究结果并没有发现在线患者数量能够直接影响门诊费用和住院费用，但是通过脉冲响应分析发现在线患者数量能够间接缓解线下医疗服务费用。因此，双渠道医疗服务模式能够缓解线下渠道中“看病贵”的问题。此外，本文还探究医生的职称等级和科室等级的调节作用，研究发现对于高等级的医生而言，双渠道服务模式的调节作用小于低等级的医生。以此可见，双渠道医疗服务模式在一定程度能够缓解目前线下医疗服务的压力，提升医院的运营效率，降低患者的服务费用。但是双渠道医疗服务模式的作用效果仍然有限，对于高职称和重点科室的“专家”医生，线上服务渠道的作用效果仍然较小，尤其是住院服务费用都显著高于低职称和非重点科室的医生。