关键词: 医联体, 基本医疗服务, 服务质量努力, 政府补贴

Abstract: Promoting primary healthcare organizations to provide high-quality services, so as to alleviate the difficulty with an appointment with doctors and reduce a high cost of medical treatment, is the key to advancing healthcare reform. To this end, the Chinese government has been constantly promoting the construction of medical alliances, trying to extend high-quality medical resources to hospitals and primary healthcare institutions that are in need of them, so as to solve the contradiction between supply and demand and the problem with a low level of governance of primary medical care. However, the long-established distribution pattern of medical resources is difficult to adjust in the short term, and the imperfect interest coordination mechanism has resulted in a slow progress in the development of medical alliances to strengthen primary healthcare. Hence, the issue of transforming the enduring limited-service capabilities of primary healthcare, encouraging patients to seek care at community level, and establishing a structured and effective diagnosis and treatment service system has attracted significant interest from policymakers and academics.
This study constructs a Hotelling model based on considering patient choice behavior. It delves into the decision-making dynamics of medical alliance participants in their efforts to enhance the quality of primary healthcare services, while also investigating the mechanisms governing patient flows and the overall enhancement of healthcare market performance. Specifically, we establish a medical alliance consisting of a tertiary hospital and a primary healthcare institution, both of which are capable of treating some common and prevalent diseases. However, there exist differences in healthcare service quality, prices and convenience. Patients choose their hospitals based on their preferences. Within the medical alliance, collaboration between the tertiary and primary hospitals is established to enhance the quality of primary healthcare services. Simultaneously, the tertiary hospital aims to decrease the number of patients with common and prevalent diseases to alleviate the patient load. On the other hand, the primary healthcare institution aims to attract more patients to reduce idle costs of equipment and personnel and improve the utilization of healthcare resources. Furthermore, we conduct a comprehensive analysis and comparison to assess how various government subsidy programs impact the decision-making equilibrium of medical alliance members and the overall equilibrium performance of the healthcare market.
The main results are as follows: 1)The establishment of medical alliance can enhance the service quality of primary healthcare facilities and encourage increased patient utilization of the primary hospital. Nevertheless, the extent of effort exerted by medical alliance and the volume of patient return are positively correlated with the initial quality of the primary healthcare institution. 2)Government subsidies promote quality improvement efforts in medical alliance by affecting its performance-cost ratio, thereby reducing its operating costs. However, the extent of cost reduction varies with the differences in the performance-cost ratios of each hospital. When the overload costs of tertiary hospital is disproportionately low, there will be a risk of diverting patients away from primary healthcare institution. 3)When the government subsidizes any member of medical alliance, with the subsidy proportion being the same and patients’ preference for healthcare quality outweighing the unit distance cost, there will be a minimum threshold for the subsidy proportion. Only when it exceeds the threshold does the overall social health surplus improve compared to the absence of government subsidies. Therefore, the government should consider quantifiable operations assessment indicators for medical alliance members, factored in hospital performance and patient preferences. This will better coordinate the impact of financial subsidies on the medical alliance’s development.

Key words: medical alliance, primary medical care, service quality efforts, government subsidies