Interest Games And Cooperation Mechanisms In The Construction Of Regional Health Informatization

Objective:To quantify research hotspots in the field of regional health informatization,compare the characteristics of different countries,analyze the relevant factors,extract the stakeholders in the construction of regional health informatization from policy perspective,reveal the interest relationship,the prisoner dilemma and the interest game process between stakeholders,provide useful information for scholars,managers,and policy makers,and help to improve the cooperation mechanisms for regional health informatization.Methods:Keyword frequency analysis,keyword co-occurrence analysis,principal component analysis,multidimensional scaling analysis,and network visualization technology were applied to identify research hotspots in the field of regional health informatization.Content analysis and social network analysis were employed to generalize stakeholders from the domestic regional health informatization policy in the period 2009—2013.Case studies,symposia,qualitative interviews and key stakeholder groups analysis were applied to explore cooperative behaviors as well as interest problems between stakeholders in the construction of regional health informatizaton.Game Theory was employed to infer the interest games process between stakeholders in regional health informatization construction.Results:(1)The total number of keywords was found to increase with time,and the research field was extensive.From 1994–2014,the research priorities shifted from hospital planning to community health planning.The number of keywords reflecting information-based research and the studies related to organizational management increasesed significantly,Partial keywords condensed into knowledge groups.There are similarities among the studies for six countries,however,the level of development and some research priorities are different.(2)The number of Medical Subject Headings(Me SH)terms increased with time.The most common subcategories of telemedicine between 1962 and 2015 were Remote Consultation,Teleradiology,and Telepathology.The most popular information communication technologies in telemedicine publications were related to the Internet and cell phones.The topics of Patient Satisfaction,Treatment Outcomes and Home Care Services associated with telemedicine were highlighted after the 1990 s.Use frequency of the terms Cell Phones and Self-Care increased drastically in the past six years,and the publication focus in six countries that had the highest output was different.(3)Domestic research started around 1984,and formed nine mainstream knowledge groups,among them,the basic information technology research and medical information research accounted for the largest share.Most studies used qualitative research methods.Domestic research cooperation groups were small-scale,Among 230 2-plexus,165(71.74%)2-plexes scale was 3,E-I Index=-0.901,which indicated that factionalism was comparatively weaker in this field,and relationship tended to occur among subgroups.A large number of regional health information technology research talents were found in army research institutes.Cooperation network was established between the provinces and municipalities,Beijing,Guangdong,Jiangsu and Hubei were the core areaes.(4)We extracted stakeholders in policies which were related to regional health informatization,among them,government,hospitals,primary health care institutions,medical insurance departments and residents were the core sectors and population.Vertical administrative agencies and horizontal departments constituted a complex cooperation network.Stakeholders in different positions had interest conflicts due to they had different available resources and need weigh investments.However,they also had interest balances.(5)Interest games lay in the whole process of system integration,cooperation mechanisms were foci in construction and improvement of regional health informatization.Among all stakeholders,government was investor,supervisor,and also was main payer.With the existing construction mechanisms and government supervision mechanisms,it was difficult to solve the problems in the resident health records,such as die files,fraud files and non-compliant files.(6)Prisoner's dilemmas might emerge because of asymmetric information,participants' poor rationality,imperfect supervision mechanisms and government officials corruption,such as the alternative in lateral government departments,unilateral prisoner's dilemma between longitudinal government departments,unreasonable games in resident health records construction.Through defining department functions,designing and implementing reward and punishments,increasing the number of game,and making full use of market mechanisms,the prisoner's dilemmas could be solved,and the department cooperation could be achieved.The problems in resident health records,such as fraud,dead file,could be resolved through increasing interaction between primary health care institutions and residents.Conclusions:The field of regional health information has experienced significant growth and expansion in knowledge and innovation in the last years.The hotspots are evolving and are at different levels of development in different countries,this phenomenon are related to national health policy,health system,geographical environment and other factors,among the factors,the policies can not be ignored.From the perspective of policy,we find that there are many stakeholders involving in regional health informatization construction,and there are complex interest relationships among stakeholders.As principal investor,supervisor,and important payer,government should analyze the interest relationships among stakeholders,improve cooperation mechanisms to solve the prisoner's dilemma.The perspective of interest game can help the government formulate policies and improve cooperation mechanism,and Game Theory is the ideal method to carry out the interest game research among the stakeholders in regional health information construction.This study quantitatively provides an objective and systematic understanding of this field,and reveals useful information for scholars,managers,and policy makers,and suggests directions for future research and construction.