中国重大传染病分级诊疗制度探究

新冠疫情给医疗资源配置工作带来了严峻挑战。分级诊疗制度是重大传染病防控下医疗资源配置的最优机制。在信息不完全的现实条件下，保证一定治愈概率和有效的医疗服务激励相容约束条件，即使不采用行政命令强制干预，分级诊疗制度依然能够保证不同患病情况的患者获得相应的最优医疗服务，同时避免“医疗挤兑”。因此，为保障重大传染病防控下分级诊疗制度的长效运行，应及时建设重大传染病分级诊疗体系、完善行政工作过渡以及精细化医疗服务转移支付激励约束机制。

Toward Building a Hierarchical Medical System for Major Infectious Diseases in China: Based on an Incomplete Information Mechanism Design

The COVID-19 epidemic continues to pose a big challenge to the allocation of medical resources. During the epidemic, it has been challenging to maximize the utility of medical resources and the efficiency of medical service systems by applying hierarchical and diversion functions. This study works from the perspective of micro-game theory, to build a principal-agent model of the medical system for major infectious diseases. Patients’ degree-of-illness, signal impulse feedback, probability of cure, and medical services transfer are included into the model, which has proved that a hierarchical model is the right choice for the maximum utility of the medical system. The model has also verified the effectiveness, scientific basis, and correctness of the hierarchical medical system.Based on theoretical conditions of complete information, the optimal mechanism of resource allocation in the medical service system is deduced under the benchmark model by using the principal-agent model. It is concluded that a hierarchical model is a scientifically systematic one that will maximize the utility of the medical system in response to the COVID-19 epidemic. In the principal-agent model, the patients’ signal impulse feedback is regarded as the critical setting of the hierarchical medical system. Although the model proposed works under the condition of complete information, and is thus not a reflection of the actual situation, it provides an optimal mechanism and results for maximizing the utility of the medical service system under the theoretical condition of complete information. It can usefully set the optimal benchmark for the real environment under conditions of incomplete information.The medical system cannot observe whether the patients’ signal impulse feedback of the hierarchical medical system is true at first. Therefore, in the case of the same information disclosure and decision-making rules, we prove that the results are consistent with the benchmark model when considering the sequential incentive compatibility of the two-stage direct mechanism. Based on the realistic condition of incomplete information, the hierarchical medical system can still ensure that patients with different degrees of illness receive corresponding optimal medical services while avoiding “medical runs” when controlling a certain cure rate and effective medical service incentive compatibility constraints. The transfer payment function in the principal-agent model can be administrative punishment, medical expenses, etc. In reality, the hierarchical medical system of the COVID-19 epidemic has a certain administrative compulsion. Due to the fact that administrative implementation may lead to the waste of political resources and abuse of administrative power, this paper introduces the medical service transfer dimension of the hierarchical medical system to ensure the sensible incentive compatibility of the mechanism under the assumption of incomplete information. Even in the case of non-administrative intervention, the hierarchical medical system is still the optimal choice for the medical system, which is the “invisible hand” of the market, promoting the maximum utility of medical resources allocation.Implementing a hierarchical medical system to prevent and control COVID-19 has effectively alleviated the pressure of “medical runs” and the spread of infection. The implementation highlights the significance of promoting the construction of the hierarchical medical system in the current medical reform. The implementation also proposes an effective mechanism design for preventing and controlling major infectious diseases. Based on this model, we put forward policy-related suggestions on the construction of a hierarchical medical system for major infectious diseases, the improvement of the administrative work transition, and the refinement of an incentive and restraint mechanism of the transfer payment such as medical services. These suggestions help to ensure the long-term operation of the hierarchical medical system for the prevention and control of major infectious diseases.