Study On The Equilibrium Strategy Of Two-level Public Health Service System Based On Patients' Medical Choice

At present,China has constructed a two-level public health service system consisting of large general hospitals and community hospitals,and established the system of tiered medical service.Many patients,however,do not behave as expected such that large general hospitals are overcrowded,and community hospitals are deserted.In order to avoid the monopoly of large general hospitals in medical service market,the government can take some measures,such as adjusting the subsidy to community hospitals and narrowing the difference of service quality among hospitals,and hospitals can decide their service capabilities and service prices to compete reasonably.Therefore,studying the equilibrium strategy of two-level public health service system has practical background and has become important research issue in the field of medical service operation and management.Based on the serious imbalance of the medical resource utilization between large general hospitals and community hospitals,we consider a two-level public health service system consisting of a profit-oriented large general hospital and a community hospital that maximizes total patient utility.The two hospitals are modelled as an M/M/I queueing system respectively.We considering the difference of service quality in two-level public health service system and establish a duopoly game model to study the competition of two-level public health service system based on medical choice of homogeneous patients and heterogeneous patients.We analyze the Nash equilibrium and the critical condition of coexistence of two hospitals in medical service market.We first consider the medical choice of homogeneous patients with same perceived value.The subsidy for community hospital do not necessarily helps increase community hospital's arrival rate of patients.Too low subsidy heightens the competition among hospitals.And the subsidy can't be sufficiently large,otherwise it would damage interests of large general hospital.We show that reducing service capacity of large general hospital is more effective than the subsidy for community hospital to promote rational flow of patients.At the same time,increasing investment in medical resources of community hospital to reduce differences of service quality among hospitals will enable patients to transfer to community hospital.We then consider the medical choice of heterogeneous patients with different perceived value.We derive the critical conditions of monopolization of medical service market by a single hospital and the coexistence of two hospitals and prove that there is a unique Nash equilibrium in the three cases.Reducing service capacity of large general hospital does not always damage interests of large general hospital.We show that reducing differences in service quality among hospitals enables patients to transfer to community hospital only when the arrival rate of patients of large general hospital is less than half of the total patients,which is different from the result when patients have same perceived value.