摘要
[目的]针对分级诊疗政策推进过程中大城市的长期服药慢性病患者的开药困境,围绕卫生部门、医疗机构和长期服药慢性病患者3个主体,探讨三方应采用的主动策略。[方法]基于演化博弈理论,构建三方演化博弈模型,考虑开药困境中三方博弈的收益、效用、成本、损失等因素,利用复制动态方程解出均衡点及三方演化博弈的稳定策略。[结果]卫生部门选择干预策略为占优策略;医疗机构中社区医院选择开药行为是占优策略;当卫生部门与医疗机构同时选择稳定策略或同时选择不稳定策略时,长期服药慢性病患者选择稳定策略为占优策略。[结论]得出三方演化博弈的稳定策略并提出建议:一是卫生部门应强化分级诊疗过程的干预作用;二是积极提升社区医院医疗服务水平;三是充分重视长期服药慢性病患者的开药诉求,着力提高其基层首诊意识。
Objective Aiming at prescribed dilemma of long-term patients with chronic diseases in large cities in process of hierarchical diagnosis treatment policy,focusing on health sector,medical institutions and long-term patients with chronic diseases,discussing that three parties should adopt initiative strategies of tripartite. Methods Constructed three-party evolutionary game model based on evolutionary game theory,and considered the factors of benefit,utility,cost and loss of three-party game in prescribed dilemma.It solved equantequation and stability strategy of three-party evolutionary game by replication dynamic equation. Results The health sector chose intervention strategy as dominant strategy.Community hospitals in medical institutions chose prescribe drugs as the dominant strategy.When health sector and medical institution chose stable strategy or unstable strategy at the same time,long-term medication patients with chronic diseases chose stable strategy as the dominant strategy. Conclusions The stability strategy of three-party evolutionary game is obtained and suggestions are put forward.First,health sector should strengthen intervention role in the process of hierarchical diagnosis treatment.Secondly,actively improve medical service level of community hospitals.Thirdly,pay full attention to prescribed appeal of long-term medication patients with chronic diseases,and focus on improving their primary diagnosis awareness.
作者
张毅
刘树奎
ZHANG Yi;LIU Shu-kui(School of Health Management of Guangzhou Medical University,Department of Scientific research,Guangzhou Guangdong 510000,China;The First Affiliate Hospital Of Guangzhou Medical University,Guangzhou Guangdong 510000,China)
出处
《卫生软科学》
2019年第5期26-31,共6页
Soft Science of Health
基金
国家社会科学规划项目(16BZX108)
广东省高等教育教学改革项目(粤教高函〔2016〕236号)
关键词
演化博弈
分级诊疗
开药困境
evolutionary game
hierarchical diagnosis treatment
prescribed dilemma
