Towards an Integrated Healthcare System: Evolutionary Game Analysis on Competition and Cooperation Between Urban and Rural Medical Institutions in China

Xu, Xinglong; Liu, Jiajie; Ampon-Wireko, Sabina; Antwi, Henry Asante; Zhou, Lülin

doi:10.3389/fpubh.2022.825328

Cited by 11 publications

(10 citation statements)

References 19 publications

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“…In line with previous studies, the current study confirmed that the effectiveness of managing public health emergencies inevitably involves coordination and cooperation between parties, although the strategic choices of participants are greatly influenced by other participants [9,24,25]. Inter-organizational collaboration can facilitate the establishment of effective methods of coordination and communication among different groups of participants [24].…”

Section: Discussionsupporting

confidence: 90%

The Whistleblower’s Dilemma: An Evolutionary Game Analysis of the Public Health Early Warning System

Cao

Zhang

2022

Discrete Dynamics in Nature and Society

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Although the ability to manage public health emergencies in China has improved significantly, there are still many challenges to the existing information transmission mechanism in pandemic early warning systems. In this context, a tripartite evolutionary game model composed of the local government, the whistleblower, and the public is formulated. By using Matlab, the dynamic evolution path of the game model is stimulated under different conditions. Stable strategies for an early warning system for public health emergencies are also explored. The results indicate that the cost of whistleblowing, the cost of response, and the benefit of attention significantly influence strategic decisions among three parties. This study highlights the importance of whistleblowing in managing public health emergencies. Yet, our findings provide theoretical support for policy recommendations for promoting public health emergency preparedness.

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Section: Discussionsupporting

confidence: 90%

The Whistleblower’s Dilemma: An Evolutionary Game Analysis of the Public Health Early Warning System

Cao

Zhang

2022

Discrete Dynamics in Nature and Society

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“…Although these data are not actual scenarios, they have some reference significance for theoretical studies, and the values of these set parameters can be used to further analyze the game process presented by the lead hospital and primary healthcare institutions under the influence of different game factors. The values of the simulation parameters were determined by referring to the related literature [32][33][34], where the healthcare problem has been studied using a similar approach. The simulation parameter values were set as follows: I = 26, U = 5, Sl = 14, Tp = 12, R = 3, Sp = 2, D = 25, v = 0.5, π = 0.5, ε = 0.5, and ξ = 0.5.…”

Section: Numerical Simulation Analysis Of the Two-subject Stochastic ...mentioning

confidence: 99%

“…Furthermore, the role of the government sector in promoting integrated healthcare needs to be explored. An evolutionary game approach is highly appropriate for systematically exploring interorganizational interactions and has been applied to different topics in the healthcare field, such as healthcare PPP projects [30], public health emergencies [31], cooperation between urban and rural medical institutions [32], online health communities [33], hierarchical diagnosis and treatment systems [34], and so on. The system dynamics approach also works well in solving complex dynamic problems [35,36] and can be used in conjunction with evolutionary game methods.…”

Section: Introductionmentioning

confidence: 99%

Information-Driven Integrated Healthcare: An Analysis of the Cooperation Strategy of County Medical Community Based on Multi-Subject Simulation

Dong

Liu

2023

Healthcare

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The fragmentation and uneven quality of primary medical resources in China call for a deepening of integrated healthcare reform. China is promoting its county medical community (CMC) reform on a large scale in county-level administrative regions to promote the integration of local primary healthcare systems through information technology, which is consistent with the current trend of the digital governance era. Considering that the construction of a county medical community involves collaborative relationships between multi-level subjects, the evolutionary game theory was adopted in this study to construct a game model between the lead hospital of a CMC and primary healthcare institutions, and then the incentives of government department support were introduced to analyze the behavioral evolution of these three subjects. Taking into account the uncertainty of the real-life environment and information transformation, white Gaussian noise was introduced as a random disturbance term, and a numerical simulation was performed. In the two-subject model we focus on four parameters: information and management authority ceded by the primary healthcare institutions, integration coefficient of CMC information construction, intensity factor of information integration in the CMC, and medical resources delivered by the lead hospital. In the three-subject model we focus on three parameters: information and portion of authority ceded by the primary healthcare institutions and government departments, policy effect coefficient of CMC construction, and intensity of government departments’ support for CMC construction. The simulation results show that there is a positive incentive for the concession of management power and information from the primary healthcare institutions to the lead hospital, but further determination of empowerment boundaries is needed. The lead hospital can improve the balance of medical resources in the county through the downward transfer of medical resources, but long-term resource delivery may inhibit the enthusiasm of the lead hospital. An improvement in the information integration intensity of the CMC can promote the efficient flow of information and knowledge and enhance the organizational closeness of the county medical community. At the same time, the integration of CMC information construction reduces the cost of collaboration among medical community members and streamlines and consolidates business modules, which can promote more efficient use of medical resources. The government departments’ policies and funds provide obvious incentives to the lead hospital and primary healthcare institutions, but there is a need to explore appropriate financial payment ratios to balance the government’s financial pressure.

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“…Cross-institutional information resource sharing often involves many stakeholders, and it could gradually approach the evolutionary stable state after repeated games. Some studies have tried to use the evolutionary game method to perform relevant research in the medical and health field, such as studying doctor-patient disputes under government regulation [ 6 ], evolutionary game of a 2-way referral mechanism [ 7 ], emergency management of public emergencies [ 8 ], knowledge sharing in online health communities [ 9 ], drug safety and public health quality supervision [ 10 , 11 ], and integrated health care systems [ 12 ]. Some studies also use evolutionary game and simulation methods to explore the willingness of medical data sharing, but these only consider the 2 parties of patients and medical service institutions [ 13 ], and fail to consider the willingness and influence mechanism of cross-agency data sharing of the government and other multiparties under the organization mode of the medical consortium.…”

Section: Introductionmentioning

confidence: 99%

Vertical Integration of Electronic Health Records in Medical Consortiums: Dynamic Modeling Approach Based on the Evolutionary Game Theory

Tian

Chen

2023

JMIR Serious Games

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Background China has continuously issued policies to speed up the interconnection, mutual recognition, sharing of medical information systems, and data integration management across regions and institutions. However, the vertical integration of electronic health records (EHRs) within the medical consortium is hampered by “poor mechanism and insufficient motivation” and the phenomenon of “free riding” among participating medical institutions, which makes the integration less effective. Objective We hope to clarify the game mechanism of stakeholders in the vertical integration of EHRs, and put forward targeted policy suggestions for improvement. Methods We constructed the “government-hospital-patient” tripartite evolutionary game model based on the detailed analysis of the research problems and their assumptions. We then simulated the game strategies and outcomes of each participant using the system dynamics approach to reveal the long-term strategy evolution mechanism of the core participants in the vertical integration of EHRs in the medical consortium, as well as the influencing factors and action mechanisms of each party’s strategy evolution to provide references for improving relevant policies. Results The evolutionary game system could eventually reach an optimal equilibrium, but in areas where the government was required to be in a dominant position, patient supervision was necessary to have a positive role, while a reasonable reward and punishment mechanism can promote active participation of hospitals. Conclusions The effective way to achieve the goal of vertical integration of EHRs in the medical consortium is to build a multiagent coordination mechanism under the guidance of the government. Meanwhile, it is necessary to establish a scientific integration performance evaluation mechanism, a reward and punishment mechanism, and a benefit distribution mechanism to promote the healthy development of vertical integration of EHRs in medical consortiums.

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Towards an Integrated Healthcare System: Evolutionary Game Analysis on Competition and Cooperation Between Urban and Rural Medical Institutions in China

Cited by 11 publications

References 19 publications

The Whistleblower’s Dilemma: An Evolutionary Game Analysis of the Public Health Early Warning System

The Whistleblower’s Dilemma: An Evolutionary Game Analysis of the Public Health Early Warning System

Information-Driven Integrated Healthcare: An Analysis of the Cooperation Strategy of County Medical Community Based on Multi-Subject Simulation

Vertical Integration of Electronic Health Records in Medical Consortiums: Dynamic Modeling Approach Based on the Evolutionary Game Theory

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