运筹与管理2024，Vol.33Issue(12)：24-31,8.DOI:10.12005/orms.2024.0382
考虑资源下沉与家庭签约的医联体多目标协调优化决策
Multi-objective Optimization of Medical Association Coordination Considering Sinking High-quality Medical Resources and Family Contract Services
摘要
Abstract
There is a serious issue of an imbalanced utilization within the current healthcare system,and how to effectively improve the utilization of public health resources while taking into account the public welfare nature of healthcare services has become a difficult problem for the government.To improve the service level of primary institutions in the hierarchical medical system,the measures of sinking high-quality medical resources from tertiary hospitals to community ones and implementing family contract services in community hospitals have been widely used.However,tertiary hospitals pay more attention to the operating income,while community ones to the patient arrival rate.The two goals are in conflict.For example,a high proportion of resources sinking can improve the medical service of community hospitals,but will affect the operating income of tertiary ones.A high proportion of family contract investment can attract more patients to community hospitals for medical treatment,but will affect their capacity construction.Therefore,the proportion of resources sinking and that of family con-tract investment are important variables affecting the coordination of medical association.To sum up,resources sinking and family contract service are the key strategies to promote the construction and development of medical association,which is of great significance to the optimization of medical resources allocation.Influenced by many random factors,our study explores the impacts of the proportion of tertiary hospital'resources sinking and that of community hospital'family contract investment on the objectives of both tertiary and community hospitals,so it improves the research background in the field of medical association coordination and optimization,and has practical significance.We provide a feasible research framework for the issue of medical service supply chain,which is of theoretical innovation significance. Considering that a dual-way referral is a key part of medical association,this paper takes the dual-way referral behavior between tertiary and community hospitals into the research scope.Given that the patient popula-tion is the medical alliance,its perceived utility cannot be ignored either.This paper establishes a computational experimental model of a dual-way referral medical service supply chain considering the resources sinking of tertiary hospitals and the family contract of community hospitals.Referring to the objective functions of the in-come of tertiary hospitals,the arrival rate of community hospitals,and the perceived utility of patients,this paper combines the random factors such as the severity of patients'conditions,self-diagnosis and personal preferences,and explores the Pareto fronts by the multi-objective evolutionary algorithms.Based on the prospect theory and Dematel-Entropy weight method,the VIKOR is used to rank the optimal Pareto frontier,and obtains the compro-mise solutions under the preferences of three decision makers.A medical service supply chain case is used to verify the feasibility and rationality of the research framework,and the results of the case show that the research framework can effectively deal with the optimization and decision-making problem of coordination among tertiary hospitals,community hospitals and patients,and has a strong validity of methodology and reliability of solutions.This paper innovatively takes into account resources sinking and family contract within the medical alliance,integrates computational experiments,multi-objective evolutionary algorithm and improved VIKOR ranking into the same research framework,which effectively improves the decision-making quality and capacity of managers and promotes the benign operations of the medical service supply chain. Our study is also subject to some limitations and various relative directions can be explored in future research.First,with the development of internet healthcare,there are multiple modes of resources sinking between tertiary hospitals and community ones,such as teleconsultation and expert consultation.Different modes of resources sinking have different impacts on the utility of resources sinking and the coordination of medical asso-ciation.Hence,resources sinking under internet medical healthcare is worthy of further study.Second,when community hospitals carry out family contract service,they will invest in online contract management,contract quality and so on.For the coordination of medical association,this is also a direction worthy of research.Last but not least,the application and development of electronic medical records is a research focus that cannot be ignored for medical association collaboration.In short,future research can discuss the medical association coor-dination under the background of Internet medical service.关键词
医联体协调/资源下沉/家庭签约/多目标优化/决策制定Key words
medical association coordination/resources sinking/family contract/multi-objective optimization/decision-making分类
管理科学引用本文复制引用
隆清琦,刘杰鹏,彭娟娟,张树柱..考虑资源下沉与家庭签约的医联体多目标协调优化决策[J].运筹与管理,2024,33(12):24-31,8.基金项目
国家自然科学基金资助项目(72171208,71771195) （72171208,71771195）
之江实验室开放课题(2021KG0AB04) （2021KG0AB04）
