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

摘要： 基层医疗服务质量低下是阻碍基本医疗均等化的重要原因。医联体的有效建设可以推进优质医疗资源下沉、提升基层医疗服务能力,进而提升社会整体医疗服务效率。构建由三级医院和基层医院组成的医联体,运用Hotelling模型考察医联体成员提升基层医疗服务质量的努力决策与患者回流的均衡结果,探究政府不同补贴情形下,医联体各成员医院最优努力策略的变化及对医疗市场均衡绩效产生的影响。研究表明:医联体能够提高基层医疗机构的服务质量,促进患者回流基层,但是质量提升及患者就诊秩序改善的程度与基层医院初始医疗质量水平正相关;政府补贴通过影响医院的绩效成本比来促进各医院质量努力提升,从而降低医院的运营成本,但成本降低程度会随着各医院绩效成本比的比值差异而有所不同;政府补贴医联体内任一成员,补贴比例相同且患者就诊的质量偏好大于单位距离成本时,政府的补贴比例应当高于门槛阈值,才能使全社会健康剩余较政府不补贴时有所提升。

关键词: 医联体, 基本医疗服务, 服务质量努力, 政府补贴