暨南学报(哲学社会科学版)

作者：宋林,邓轶嘉

单位：博士,西安交通大学经济与金融学院教授,博士生导师。邓轶嘉,西安交通大学经济与金融学院博士生。

关键词：分级诊疗,政策偏好,基层(全科)医生,(非)严格分级诊疗体系,社会福利

本文基于中国现行的医疗体制改革背景,以基层医生作为研究社区首诊式分级诊疗体系的突破口,先从理论上厘清决策者政策偏好,再通过基层医生的技术和道德水平这两个特征对其诊疗行为的影响来评估不同条件下的社会福利,从一定程度上解释了中国现行的分级诊疗模式在提高医疗效率方面效果不显著的真正原因,并对其未来如何根据政策偏好及医疗供方特点对现有医疗资源进行合理配置给出了理论参考。结果表明:(1)一刀切的严格分级诊疗模式不一定符合社会福利最大化的原则,应综合考虑政策偏好和基层医生特征建立分级诊疗模式;(2)政策偏向于节约成本时,严格分级诊疗更优,政策偏向于患者健康时,非严格分级诊疗更好;(3)选取分级诊疗模式时,应该将医生的职业技能水平和职业道德水平作为重要的参考指标。"/>template{display:none;}.mag-rich-xref-fn { cursor: pointer;}//长视频$(document).ready(function(){if($("#showLongArticleVideo") && $("#showLongArticleVideo").length && $("#showLongArticleVideo").length>0){mag_ajax_update({ele_id:'showLongArticleVideo',url:mag_currentQikanUrl() + "/CN/article/showLongArticleVideo.do?id="+$("#articleId").val()});}});$(document).ready(function(){window.metaData = {"journal":{"issn":"1000-5072","qiKanMingCheng_CN":"暨南学报（哲学社会科学版）","id":2,"qiKanMingCheng_EN":"Jinan Journal"},"article":{"keywordList_cn":["(非)严格分级诊疗体系","分级诊疗","基层(全科)医生","社会福利","政策偏好"],"juan":"40","zhaiyao_cn":"本文基于中国现行的医疗体制改革背景,以基层医生作为研究社区首诊式分级诊疗体系的突破口,先从理论上厘清决策者政策偏好,再通过基层医生的技术和道德水平这两个特征对其诊疗行为的影响来评估不同条件下的社会福利,从一定程度上解释了中国现行的分级诊疗模式在提高医疗效率方面效果不显著的真正原因,并对其未来如何根据政策偏好及医疗供方特点对现有医疗资源进行合理配置给出了理论参考。结果表明:(1)一刀切的严格分级诊疗模式不一定符合社会福利最大化的原则,应综合考虑政策偏好和基层医生特征建立分级诊疗模式;(2)政策偏向于节约成本时,严格分级诊疗更优,政策偏向于患者健康时,非严格分级诊疗更好;(3)选取分级诊疗模式时,应该将医生的职业技能水平和职业道德水平作为重要的参考指标。","endNoteUrl_en":"https://jnxb.jnu.edu.cn/skb/EN/article/getTxtFile.do?fileType=EndNote&id=6102","reference":"","bibtexUrl_cn":"https://jnxb.jnu.edu.cn/skb/CN/article/getTxtFile.do?fileType=BibTeX&id=6102","abstractUrl_en":"https://jnxb.jnu.edu.cn/skb/EN/Y2018/V40/I6/30","qi":"6","id":6102,"nian":2018,"bianHao":"2018-6-30","zuoZheEn_L":"SONG Lin, DENG Yijia","juanUrl_en":"https://jnxb.jnu.edu.cn/skb/EN/Y2018","shouCiFaBuRiQi":"2018-06-22","qiShiYe":"30","qiUrl_cn":"https://jnxb.jnu.edu.cn/skb/CN/Y2018/V40/I6","lanMu_cn":"经济·管理","pdfSize":"725","zuoZhe_CN":"宋林,邓轶嘉","risUrl_cn":"https://jnxb.jnu.edu.cn/skb/CN/article/getTxtFile.do?fileType=Ris&id=6102","title_cn":"基层医生对中国分级诊疗模式选择的影响研究","jieShuYe":"40","keywordList_en":["(non) strict classification of medical treatment","hierarchical diagnosis and treatment system","policy preferences","primary-level doctors","Social welfare"],"endNoteUrl_cn":"https://jnxb.jnu.edu.cn/skb/CN/article/getTxtFile.do?fileType=EndNote&id=6102","zhaiyao_en":"Based on the background of China’s current medical system reform, this paper focuses on primary doctors as a breakthrough for researching the community’s first-option mode of diagnostic and treatment system. The paper theoretically clarifies the policy preferences of policymakers, and then adopts the two characteristics of the doctors’ capabilities and moral integrity. The impacts of the two characteristics on hierarchical diagnosis and treatment system to assess the social welfare under different conditions, to a certain extent, explain the fact that China’s current hierarchical diagnosis and treatment system has not played a significant role in improving the efficiency of medical treatment. And the impacts also provide a theoretical reference for the rational allocation of existing medical resources for the future, according to policy preferences and the characteristics of medical providers. The results show that: 1) The one-size-fits-all model of strict hierarchical diagnosis and treatment system does not necessarily conform to the principle of maximizing social welfare. A hierarchical diagnosis and treatment system should be established based on a comprehensive evaluation of the policy preferences and the characteristics of primary-level doctors; 2) Strict classification of medical treatment is more favorable when preferential policy is towards cost-saving; the non-strict classification of medical treatments comes better when the policy is patient-oriented; 3) When selecting a graded treatment model, the doctor’s professional skills and ethics should be evaluated as important reference.","bibtexUrl_en":"https://jnxb.jnu.edu.cn/skb/EN/article/getTxtFile.do?fileType=BibTeX&id=6102","abstractUrl_cn":"https://jnxb.jnu.edu.cn/skb/CN/Y2018/V40/I6/30","zuoZheCn_L":"宋林,邓轶嘉","juanUrl_cn":"https://jnxb.jnu.edu.cn/skb/CN/Y2018","lanMu_en":"","qiUrl_en":"https://jnxb.jnu.edu.cn/skb/EN/Y2018/V40/I6","zuoZhe_EN":"SONG Lin, DENG Yijia","risUrl_en":"https://jnxb.jnu.edu.cn/skb/EN/article/getTxtFile.do?fileType=Ris&id=6102","title_en":"Research on the Influences Brought by Primary Doctors on Choosing the Appropriate Hierarchical Diagnosis and Treatment System in China","hasPdf":"true"},"authorNotes_cn":["宋林,博士,西安交通大学经济与金融学院教授,博士生导师。邓轶嘉,西安交通大学经济与金融学院博士生。"]};if(window.metaData && (!window.metaData.authorNotesCommon_cn && !window.metaData.authorNotesCorresp_cn && window.metaData.authorNotes_cn)){window.metaData.authorNotesCommon_cn = window.metaData.authorNotes_cn;}if(window.metaData && (!window.metaData.authorNotesCommon_en && !window.metaData.authorNotesCorresp_en && window.metaData.authorNotes_en)){window.metaData.authorNotesCommon_en = window.metaData.authorNotes_en;}var _nlmdtdXml = $("#article_nlmdtdXml").val();var magDir = _nlmdtdXml.replace(/\/[^\/]+$/,'');window.metaData.magDir = magDir;new mag_vue({ el: '#metaVue', //dataUrl: mag_currentQikanUrl() + '/EN/article/getRichHtmlJson.do?articleId='+$("#articleId").val(), data:window.metaData, loading:true, doTextFun:function(text){ return doDataJsonText(text); 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来源：2018年第6期

《暨南学报(哲学社会科学版)》期刊编辑部

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