医疗信息共享对患者转移数量和服务质量水平影响研究

当前我国医院间存在严重的"信息孤岛"，医院参与医疗信息共享意愿不高，患者的诊疗信息被静态碎片化储存而无法充分有效地利用。考虑到医院进行医疗信息共享将降低患者转移成本，本文构建一个多阶段双寡头动态博弈模型研究医疗信息共享对医院竞争过程中患者转移数量和服务质量水平决策的影响。首先，根据是否存在转移成本，将患者分为新患者和经验性患者，借助Hotelling模型刻画患者的效用函数，分析患者就诊决策。然后，在政府价格规制和不考虑医院利他性情景下，构建了医院累积期望收益目标函数，使用动态规划方法，求解实现医院累积期望收益最大化的服务质量水平，获得了实现患者相互转移且医院在市场中共存的马尔可夫完美均衡。最后，根据医院参与医疗信息共享后患者转移成本降为零，分析与比较信息共享前后患者转移数量和服务质量水平变化。研究发现：在不同医院间本身存在患者转移背景下，医院参与信息共享后，患者转移数量增加但存在一个上限，增加的转移量与患者在医院间的转移成本呈正相关，与初始感知效用的差值范围呈负相关；医院参与信息共享后，均衡状态下的医院服务质量水平高于信息共享前的服务质量水平。因此，在不改变当前医保支付方式下，要加快推进医疗信息共享，政府部门可以根据医院的患者数量和服务质量水平变化对其进行定期补贴，以激励医院积极参与医疗信息共享，本文给出了这个补贴的量化表达。

The Impact of Health Information Exchange on the Number of Patients Transferred and the Quality of Service

At present,there are serious"information island"among hospitals in China.The willingness of hospitals to participate in health information exchange is not high,and the health information of patients is stored in static fragments and cannot be effectively utilized.Considering that health information exchange in hospitals will reduce the switching costs of patients,a multi-stage duopoly dynamic game model is constructed to study the impact of health information exchange on the number of patients transferred and the quality of service during the hospital competition process.First of all,according to whether there is switching cost,patients are divided into new patients and experience patients,and the utility function of patients is described using Hotelling model,which aims to analyze the decision-making of patients.Then,under the circumstances of government price regulation and without considering the hospital’s altruism,the objective function of the cumulative expected revenue of the hospital is constructed,and the dynamic programming method is used to solve the optimal service quality level of maximizing the cumulative expected revenue.The Markov perfect equilibrium for achieving patients mutual transferred and the coexistence of hospitals in the market is obtained.Finally,according to the fact that the patients switching costs is reduced to zero after participating in health information exchange,the changes of the number of patients transferred and the service quality are analyzed and compared.It is found that in the context of patients transfer among different hospitals before participating in health information exchange,the number of patients transferred is increased but there is an upper limit after participating in health information exchange.The increased number of patients transferred is positively correlated with the switch costs,but negatively correlated with the initial perceived utility difference.The level of service quality under equilibrium is higher than that before participating in health information exchange.Therefore,without changing the current mode of medical insurance payment,to accelerate the promotion of health information exchange,the government departments can regularly provide subsidies to hospitals based on the changes in the number of patients and the level of service quality,so as to motivate hospitals to actively participate in health information exchange.A quantitative expression of this subsidy is given in this paper.