——李娜 杜涛 李金玉

【摘要】目的 构建不同付费方式下医联体患者病床安排优化模型，提高医院服务效率。方法 基于医联体背景，将患者分为急诊患者、转诊择期患者、普通择期患者，构建不同付费方式下以收益最大化为目标的医联体患者病床安排优化模型，并基于延安市医联体内某三甲医院实际数据进行案例求解与分析。结果 采用按项目付费时，使用整数规划模型能够使医院收益提高189.9%；采用按DRGs付费时，使用整数规划模型能够使医院收益提高61.9%。结论 不同付费方式下医联体患者病床安排整数规划模型在一定程度上提高了医疗资源使用效率，对DRGs政策实施后的患者病床安排问题具有一定现实意义。

【关键词】医联体；按项目付费；疾病诊断相关分组；床位安排

中图分类号：R197.323文献标识码：A

Optimization of Bed Arrangement in Medical Consortium under Different Payment Methods/LI Na,DU Tao,LI Jinyu.//Chinese Health Quality Management，2022,29(7):52-57

Abstract Objective To construct an optimization model for hospital bed arrangements for medical consortium patients under different payment methods to improve hospital service efficiency.Methods Based on the medical consortium background, patients were divided into emergency patients, referral elective patients, and ordinary elective patients, and constructed an optimization model of hospital bed arrangement for medical consortium patients in the context of different payment methods with the goal of revenue maximization. Case-solving and analysis of actual data from a tertiary hospital in medical consortium in Yan'an was done.Results When the hospital adopted the fee-for-service, the integer programming models could improve hospital benefits by 189.9%. Using the integer programming model to pay for DRGs, the hospital benefits increased by 61.9%.Conclusion The constructed optimization model of hospital bed arrangement for medical consortium patients under different payment methods had improved the efficiency of medical resource utilization to a certain extent, and has certain practical significance for the patient bed arrangement problem after the implementation of the DRGs policy.

Key words Medical Consortium; Fee-for-Service; Disease Diagnosis Related Groups; Bed Arrangement

First-author's address School of Economics and Management, Yan'an University, Yan'an, Shaanxi, 716000, China

近年来，随着医改的持续深入推进，医疗资源供给总量显著提升，但优质资源匮乏、分配不均等问题依旧存在，主要表现为二三级医院占有大量优质资源，导致大量患者涌入大医院，造成大医院拥堵问题严重。如何提高服务效率，是我国医院管理者思考并探索的问题。原国家卫生计生委《2015年卫生计生工作要点》（国卫办发〔2015〕3号）中提到，要以高血压、糖尿病等慢性病和结核病防治管理为突破口，探索按病种打包、上下联动等方法，构建基层首诊、双向转诊、急慢分治、上下联动的分级诊疗模式。《中华人民共和国国民经济和社会发展第十四个五年规划和2035年远景目标纲要（草案）》也明确要求推行以按病种付费为主的多元复合式医保支付方式。在有限的病床资源条件下，针对不同类型（急诊、转诊择期、普通择期）患者，如何合理安排患者入院顺序及时间，以降低医院成本、提高医疗服务效率，是本研究亟待解决的问题。

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