Research On The Promotion Mechanisms Of Two-Way Refferal Based On Game Model

To cope with the shortage of resources under the hierarchical healthcare system and the imbalance of utilization rates of higher-and lower-level hospitals,the Chinese government has proposed policies such as healthcare alliance and two-way referral.However,in the practice of referrals,there are still problems such as inconsistent interests of higher-and lower-level hospitals and insufficient motivation for referrals.Therefore,this paper studies the coordination and promotion mechanism for the two types of problems respectively: downward and upward referral.As to the downward referral problem,this paper proposes a referral promotion mechanism based on revenue sharing,and establishes a threestage decision-making cooperative referral sequential game model.To begin with,the higher-level hospital selects a suitable lower-level hospital as a partner.After that,a referral mechanism based on revenue sharing is analyzed to investigate how the collaboration between two hospitals.Finally,through case study and numerical analysis,the paper discusses the impact of partnership strategy between hospitals on benefit,decision-making and patient waiting time under the mechanism,so as to promote the promotion and implementation of rehabilitation(micro disease)downward referral.As to the upward referral problem,this paper proposes a referral promotion mechanism based on service payment,and establishes a sequential game model of non-competitive and competitive referral models.The two models first study the optimal referral threshold policy under the centralized decision-making and the optimal contracting form under the service payment contract cooperation mode.Then,the existence and coordination conditions of the perfect coordination and imperfect coordination of the system are discussed.Finally,with numerical case analysis,the factors such as the size of healthcare scale and with or without competition for the coordination efficiency are carefully studied.The main conclusions are as follows.Firstly,the higher-level hospitals should adopt the optimal partnership strategy to match the lower-level hospitals that can accept downward referrals under certain conditions.Secondly,the higher-level hospitals can adopt the reverse payment strategy to promote the cooperation of downward referral under few conditions.Thirdly,the coordination efficiency of small-scale competitive system is higher than that of large-scale non-competitive system,so it is suggested to consider the design an efficient system: multi-small higher-level hospitals with few-large lower-level hospitals.