Cooperative Strategy And Cooperative Game Model For Public Hospitals

[Purpose]The objectives of this study fall into two broad categories.(1) After a comprehensive understanding of the medical service management and the status of health care reform on public hospitals, stakeholder relations and game behavior, collaborative mechanism, ways and means to solve the interest conflicts, service system and present situation, formation mechanism and implement mechanisms for public hospitals are discussed in this paper by the use of stakeholder theory, cooperative game theory, synergetics, contract theory and so on. A cooperative strategy and corresponding assessment of gap are proposed in this work. The method of gap assessment of public welfare index is presented and explained by taking the gap assessment of commonweal as an example.(2) The tradeoff in the interest of the major hospital stakeholders and then the solution of conflicts between public-hospital stakeholders are studied deeply on the basis of the above discussion. The dynamic conditions and basic of major interest body are analyzed for public hospitals. A cooperative game model of the main interest groups of public hospitals is built based on cooperative game theory through the analysis of the game conditions. The synergy in public hospitals (policy objectives) and the policy responses of government reform of public hospitals (policy application acted as tools and paths) are studied to build the game model from the point of view the policy game. Cooperative outcome is derived from constraints. The Shapley value is used as an allocation strategy of cooperative game, in which the calculation of the marginal benefit and the marginal contribution are all required. Instance analysis gives us some useful inspiration on China’s public hospital reform. An important theoretical basis for the collaborative reform of public hospitals, practical guidance and policy recommendations are provided in this work.[Methods](1) Document Analysis1) By the use of non-structural and non-quantitative documentary method monographs, professional journals, proceedings, and online retrieval, etc. were consulted to collect the domestic and international information of reform and the situation of public hospitals and service system. In such a way, we knew the Development of Public Hospital.2) Practical application and typical cases in all fields about stakeholder theory, coordination theory and cooperative game theory were collected to provide a reference for research on coordination theory which was applied in China’s public hospital reform.3) Application achievement in the health system, research findings on stakeholders game, and the change of domestic and foreign policy on the web of World Health Organization and the health administrative departments were collected to provide a reference and basis for this research.(2) Analysis of Typical CasesAccording to core issues and critical information in the public hospital reform and development, some typical cases were chose for case studies and analyzes.1) Policy reforms of public hospitals in Chongqing, a pilot area in the collaboration mechanism and strategy, were studied to find a way to the public hospital reforms.2) The medical market reforms, as typical cases of building a cooperative game model of Cooperation reform, were studied to analyze countermeasures effect of path selection of interest bodies and the results of policy tools under the policy preferences, and thus the preference assumptions of cooperative game model was derived. The key issues in the process of public hospital reform were obtained through case studies.(3) Gap Assessment Method Based on Coordinate AnalysisThe gap between the real level of development of the public hospital system and the desired one was assessed and explained by coordinate analysis, and then the real commonweal data of public hospitals were collected. The gap assessment method was introduced by taking the assessment of commonweal gap as an example. A method of gap assessment of commonweal index of hospitals and a concept of satisfaction degree of public benefit coordination were proposed in this work. The necessity and value of collaboration were illustrated in a sense. The method and path on quantitative evaluation of social results were provided to build cooperative game model.The gap assessment method can also be used to conduct a gap assessment of service efficiency or management efficiency of public hospitals, while it takes into account the commonweal and operating efficiency of public hospitals. At the same time, the method provides a way of effective macro-control and supervision for decision and management, real-time grasp of the change of commonweal efficiency, management efficiency and service efficiency. According to the results, an early warning mechanisms can be built to avoid public hospitals deviated from the direction of welfare reform. An objective, authoritative information is provided to assess the degree of social welfare and to choose the hospital with the strong sense of social responsibility by regularly publishing "Public hospital index value". On the other hand, the method also gives hospitals a forced pressure by adopting a mechanism of the survival of the fittest.(4) Analyzing with game method and building cooperative game model of public hospitalsAfter knowing the status of the economy, the understanding of the public hospital, the change of multistakeholder structure of hospitals and its impact on the public hospital system were analyzed based on the stakeholder theory. After system analysis of the behavior of major stakeholders in the target system, the interaction between the major stakeholders and their behavioral characteristics were studied based on optimization principle of production and utility. The conditions for cooperation of the research objectives were investigated based on the theory and model of cooperative game, on which the key mechanism of interests exchange and cooperation were analyzed and deduced, and the game path, strategy selection and game results of stakeholders were simulated. Finally, the mechanism to promote cooperation of stakeholders was discussed in this work.By analyzing and extending the game conditions, the cooperative game model of core stakeholders of public hospitals was built based on the basis of ideas and principle of cooperative game theory. A reasonable allocation scheme was designed by using Shapley algorithm, which can make the fairness, and the constraints of rights, responsibilities and interests in the cooperation. It is found that incentive compatibility is a way to achieve synergy. (See Chapter 5 for a detailed technical presentation)(5) Shapley valueThe Shapley value, which is based on three axioms, is a distribution strategy proposed by the Shapley in 1953. The Shapley value is used to allocate total revenue according to marginal contribution of each player, which thus ensures the fairness of distribution.Advantages of the Shapley value:The Shapley value pays more attention to the amount of the contribution of the members according to which the income of players is decided. The Shapley value focuses on the use efficiency of resources and the income generated by the integration, rather than how much the members possess or invest, that is, the greater the player contributes, the more he incomes. For this reason, the Shapley value is a good approach to fair allocation. Moreover, it promotes the management innovation, behavior coordination, cost reduction and active cooperation in order to achieve the best benefits. In sum, the Shapley value is a nice incentive to enhance equity and efficiency.[Results](1) On theory and conceptFacing the issue in medical reform, the game of public policy, which was the guidance in this study, was defined after depth analysis of the game theory.According to research purposes a series of important concepts were presented. For example, medical contracts, cooperative game, incentive compatibility, value-added incentives, synergy.Based on theoretical principles, a series of concepts related were presented, for example, policy instruments, the objectives of social function of public hospitals, the objectives of social policy of public hospitals, contract management, pricing human capital in hospitals, property management of human capital in hospitals. These laid a solid theoretical basis for further study such as modeling, countermeasures design and so on.Because of the decline in public service, two new concepts about commonweal assessment were created in this research. They are "gap assessment of commonweal index of hospitals" and "collaborative satisfaction of commonweal", which enrich the theory on hospital assessment.(2) On method studyTo meet policy objectives and people’s health requirements, the need for collaborative reform of public hospitals was researched, the gas between policy objectives and people’s requirements was presented, and then the method based on coordinate analysis to assess gaps was explored.Multiplayer cooperative game was introduced to explore the barriers of coordinated reform. This method was illustrated by the game model with four players, i.e., public hospitals, the government, health insurance organizations, public (patients). How to apply Shapley value to obtain equitable distribution was explored also in this work.It is obvious that this paper has achieved a certain methodological innovation.(3) On research1. By research on domestic and foreign services system of public hospital the results can be drew as follows.Foreign service system has a good advantage such as medical grade, rapid diagnosis and treatment, convenient procedure, medical triage, a reasonable allocation of health resources. Furthermore, strict administration and strategy on hospital choice reduce the burden of the second-class and tertiary hospitals. Family doctor system in the community plays a good role in first diagnosis. More attention must be paid on the union of the market and the government, that of institutional arrangements and mechanisms design, and inter-agency cooperation.Compared to foreign systems, the lack of medical resources, low quality, the irrational structure, fragmented service system, the unreasonable size of some public hospitals are the outstanding issues in China.After the investigation of the cooperative status of the service system of public hospital, the cooperative forms were classified for the convenience of the reform. The level, goals and objectives of collaboration modes were established to make the reform goals more clear. Field research was carried out at three points located in western, central and eastern city of China, respectively. They are Chongqing, Xiangyang in Hubei and Ningbo in Zhejiang. The development and impact of reform was analyzed, and the attitude of the patient and medical personnel about reform was investigated through satisfaction surveys.2. Based on cooperation mechanism, the motivation, implementation, collaboration, requirement and results of cooperation were analyzed, and then the findings were obtained as follows.1) The model framework of collaborative mechanism of public hospitals was built on the base of cooperative theory.2) The analyses of the formation mechanism of collaboration.The method of gap assessment was proposed based on the investigation of the goals and running state of public hospitals system. It is apparent that a reasonable allocation plan must be formed in order to implement reforms synergies based on the key mechanisms of collaboration, i.e., benefit distribution mechanism. This provides a foundation of cooperative game theory for the equitable distribution.3) Analysis of implementation mechanism of cooperation.Public hospital system staying in an unstable state or far from equilibrium state is a prerequisite for identifying opportunities for synergies through the analysis of opportunities for collaboration of public hospitals. Medical reform should obey the principles of environmental adaptability, the principle of complementarity of resource function, the principle of complementarity of synergy value, the principle of cooperation and good faith, the rationalization principle of collaborative cost. A method to assess the actual value of collaboration was proposed by comparing the synergy value with its cost. The pre-assessment of the synergy value can predict synergistic effect, which is important for distribution of cooperation benefits. The ways and means of collaboration in information communication, that is, medical contractual cooperation, were presented based on contract theory. The approach and principles of the integration were presented after cooperation element analysis. Moreover, the selection and management principles of the order parameters and feedback mechanism were proposed in this paper.4) Strategy mechanismi) The collaborative action strategies were proposed, which including environmental learning, cooperative evolution and agile action.ii) The collaborative strategy with market competition and compensation mechanism was presented through government procurement of services.iii) The mobility to the medical staff promote the management strategy of human capital.3. Analyzing with game method and building cooperative game model of public hospitalsThe game rules and the participants and other factors were analyzed based on reasonable assumptions. Finally, participants of model construction should be the main stakeholders of collaborative reform of public hospital.Based on systematic analysis of each stakeholder in the target system, the key mechanism of interests exchange and collaboration was analyzed and derived. The analyzed results and integrated policy sets were drew. The cooperative game model was built in which plays were public hospitals, the government, health insurance organizations, public (patients). The possibility, mechanism, path and countermeasure of cooperative game were discussed with policy guidance, collaborative strategy. At last, how to apply Shapley value to obtain equitable distribution was explored also in this work. Some useful inspirations for the reform of public hospitals in China were drawn after evaluation of cooperative game and analysis of risk aversion.[Conclusions](1) On the theoretical and conceptual aspectsThe game of medical public policy is defined as the process of selecting a behavior which can obtain utility maximization with such constraint as constitution, laws, regulations, habits, mindset and cultural traditions.This paper gives some important concepts such as medical contracts, value-added incentive. Among law contract, the medical contract is a good approach to construct institutional order.This paper believes that the only way to stimulate and improve enthusiasm for work of the medical workers is to optimize hospital human resource, proper evaluation of medical human capital and management of property rights. This may rebuild the value chain of behavior mechanism of medical personnel and management personnel. Furthermore, it makes medical human capital value highest, economy developing and society beneficial.(2) On research methodsThe gap assessment is good at the rational allocation of health resources, which may promote and deepen the reform medical and health system. The method takes into account the public interest and operational efficiency, and hence it can avoid deviation direction in welfare reform, while ensuring operational efficiency. The suitable hospitals can be recommended for patients, which promotes hospital development. For this reason, the gap assessment can be used in wide field of application.(3) On findings1. Findings on service system of the public hospital at home and abroadService system of abroad public hospital pays more attention to basic health services based on community health care. Therefore, it tends to have higher input-output ratio. The primary health care services, which the government provides to the patient through the purchase of the service, are usually managed by a private organization. This avoids building redundant project, low efficiency and even inefficiency. The public services pay attention to teamwork, partnerships and reputation. Cooperation and collaboration improve quality of care and reduce medical costs. It is reasonable that market mechanism is introduced in medical service system and individual physicians is encourage to open primary medical institutions.In health care system in China, there are some issues such as the lack and error of system, irrational resource allocation, the lack divide the work, the decline of commonweal.2. Findings on collaboration mechanism and strategyThe assessment mechanism of public hospitals should be established in the formation stage of collaboration. The goals of public hospital system, including functional goals and policy objectives, should be determined in advance so that the direction of reform is clear for every person involved. The gaps in public hospital reform should be assessed and welfare index should be published regularly, which can guide hospital behavior. A reasonable allocation scheme, incentive compatibility and the Nash equilibrium are required in hospital management.Public hospital system staying in an unstable state or far from equilibrium state is a prerequisite for identifying opportunities for synergies through the analysis of opportunities for collaboration of public hospitals.3. Findings on game analysis and cooperative game modelBy analyzing and studying cooperative game, the results of cooperative games which take into account both fair and efficient is considered as compromise and consensus of stakeholders after game and communication. And it is also the harmony of individual interests of medical staff.Cooperation strategy takes into account both the optimization of financial investment and the initiative of service providers. This ensures the efficient use of medical resources and optimal allocation of medical resources. The results has a positive meaning for the management of public hospitals, coordination behavior, reduce costs.4. Realization route and recommendationsRealization route:i) The top structure of synergies system must be designed at first. And then the institutional barriers should be found. Synergies order is created at last. These systems include sound governance structure of public hospitals, the optimal management system, cooperative mechanism of the internal management of public hospitals, compensation channel of innovative stakeholder, and so on.ii) The service system should be strengthened. The functional collaboration and use efficiency of hospitals should be enhanced.iii) The market should be cultivated and optimized. Payment means should be innovative. The synergy of behavior and competitiveness should be strengthened for a long-term development.Recommendations:i) The gap in public hospital reform should be evaluated correctly. And welfare index should be regularly published. Those can guide hospital behavior and ensure public welfare orientation.ii) The collaborative route should be designed.In general, we should pay attention to the issue of reform, use of effective policy decisions and guidance theory. The ultimate realization of synergies reform of public hospitals.[Innovation and insufficient](1) The theory with reality, starting with the reform of key issues, find solutions to problems in the effective theory, critical thinking mechanism and method of problem-solving path. There are some innovations in the study of theory:First, proposed a "public health policy game", "medical contract", "cooperation contract", "value-added incentives," "Health of Human Capital Property" and other reform issues to deal with new concepts, In a related theory extends the theory to do, to solve the real problems of deep reform of public hospitals, the formation of a new theoretical evidence for certain reforms. The second is the decline in public interest issue, create a new concept of public welfare assessment methods in the study:one is "Hospital Public index Gap Assessment Law," the second is "collaborative nonprofit satisfaction" concept; expand the theory hospital assessment in accordance with. It has a theoretical value of innovation;In the process, the study needs coordinated reform of public hospitals, to meet policy objectives, to people’s health requirements, propose gap assessment between the two explored to assess gaps, creating a gap assessment method coordinate analysis, and gap assessment results explored the unity and determination of method evaluation method of collaboration satisfaction. In addition, the introduction of countermeasures multiplayer cooperative game analysis method, in order to build public hospitals, government, health care, public (patients) four Cooperative Strategy Model of interpretation of this method, and to explore the use of calculus examples Shapley evaluation equitable distribution Public hospitals cooperation benefits. Explore the interests of coordinated reform of barriers. To achieve a certain methodological innovation.(2) Due to the limited knowledge of game analysis, game theory and learned from the classics only highlighted the strategic actions and results of the individual participant interaction in small groups when the number until it is hard to analyze large groups of people Game countermeasures, so in this paper mainly in core body consider cooperation strategies and game, to do a comprehensive analysis multiplayer cooperative game as much as possible on the technical process, not just trying to seek perfection, although the overall collective action so far is inside a problems, but the game is still a long-term direction of the research and study of long-term concern.