目的 分析三级医院重症患者康复期，医保部门、医院、患者三方之间的利益关系，探讨政府不同协调策略下，医院和患者策略的演化路径及其影响因素。方法 通过构建医保部门、医院和患者三方的演化博弈模型，利用Matlab软件进行仿真分析。结果 医保部门积极补贴策略下，更易形成医患双方共赢的局面；消极补贴策略下，则易导致卫生总费用增加但患者难下转的恶性循环，进而导致患者对三级医院的信赖感下降。结论 明确政府在推进分级诊疗中的协调主体地位；充分发挥医疗保险的经济杠杆作用；推进基层医疗卫生机构的设施建设和家庭医生签约服务；通过多种手段更好地宣传和落实分级诊疗措施。

Objective To analyze the interest relationships among healthcare security authorities, hospitals, and patients during the recovery period of critically ill patients in tertiary hospitals and to explore the evolution path and influencing factors of hospital and patient strategies under different coordination strategies of the government authorities. Methods The evolutionary game model involving healthcare security authorities, hospitals and patients was established, and simulation analysis was performed using the Matlab software. Results An active subsidy strategy by healthcare security authorities helps form a win-win situation for both hospitals and patients; in contrast, a passive subsidy strategy may lead to a vicious circle, in which the total health cost increases, but patients are difficult to be transferred to lower-level hospitals, which in turn leads to a decline in patients' trust in tertiary hospitals. Conclusions Government authorities should play a central role in promoting hierarchical diagnosis and treatment. Medical insurance should be given a full play to economic leverage. The construction of facilities in grassroots medical institutions and the family doctor contracting services should be promoted. Hierarchical diagnosis and treatment should be advocated and implemented through a variety of means.