Research On The Operation Of Healthcare Alliance Referral Based On Threshold Control Policy

In China,due to lack of clear regulation on care pathway of patients,it is commonly observed that the system experiences substantial utilization imbalance.One way to address this challenge is creating healthcare alliances.Among the alliance,patients can be referred from high utilized hospital to low utilized one for services that can be provided in both types of hospitals with similar service qualities.Due to the lack of corresponding scientific and quantitative methods,it is unclear for medical institutions to control the referral decision process.Therefore,this paper studies two random control strategies for cooperative referral of multiple hospitals and multiple diseases.As to study on control strategy of cooperative referral in multiple hospitals,a threshold control decision model based on the number of bed resources is constructed to make a decision for high utilized hospital about whether to refer patients out.Then,we analyze five different selection strategies to determine the low utilized hospital which the patient is referred to.We also developed a simulation optimization algorithm for generating best control threshold.For multi-type patients with different disease conditions,a method of determining the types and quantities of patients should be referred is explored based on ensuring the respective interests of two level of hospital simultaneously.This paper proposes a threshold control method to address these issues along with the Pareto-based negotiation process and simulation optimization algorithm to implement referral.Simulation experiments are performed to make some analyses.Firstly,the results show that sending patients to the low utilized hospital with the lowest available bed rate status is the best strategy.Secondly,we find that the favorite referral type of patients is moderately profitable patients(patients with medium per-capita per day revenue)for the cooperation system.Lastly,in order to make the threshold control easier to be implemented,we further propose a simplified referral control method and conclude that when the flow variability is small,the method can approach similar effects as the previously proposed control while significantly reducing the administrative costs.