Development of the family doctor service: an evolutionary game theory analysis

Family physicians play a prominent role in the primary health care system of several countries and regions. This study examined family doctors, community residents, and general hospitals, and found that their behaviour and decisions were inevitably affected by multiple economic concerns. To explore the influence of these economic factors, we established a tripartite evolutionary game model. Based on this dynamic game model, we examined the equilibrium of their interactions, effects of relevant parameters, and evolution trends of different scenarios. The main result shows that the participation of general hospitals is crucial to the construction of the family doctor service; that is, to develop the family doctor service, the government should focus on financial compensation for general hospitals rather than for family doctors.We further concluded that the compensation mechanism of contracted services plays a vital role in attracting physicians’ participation; thus, policymakers should consider these in different stages of the promotion of the family doctor service

The effects of contract mechanisms between the government and private hospitals on the social utility

In this work, we deal with a real healthcare system, in which public and private hospitals with different characteristics co-exist. While public hospitals have lower costs, they also suffer from long waiting times, diminishing the perceived quality of care for patients. Conversely, private hospitals, with their higher fees, offer shorter waiting periods, resulting in a more favorable perception of quality. A balanced healthcare system could offer societal benefits. Pricing strategies greatly influence a patient's hospital selection. For instance, reduced fees in private hospitals attract more patients, consequently reducing overcrowding in public facilities and elevating the overall quality of services provided. This study aims to develop pricing models to foster a balanced and socially advantageous healthcare system. Within this system, private hospital pricing is determined through contract mechanisms with the government. Thus, we delve into the ramifications of various contract models between the government and private hospitals on social utility. Our findings underscore the communal advantages of contract mechanisms. Furthermore, we generalize the proposed models to be applicable to similar systems.info:eu-repo/semantics/publishedVersio

It takes three to tango: Soft budget constraint and cream skimming in the hospital care market

Cream skimming is an illegal behaviour that consists in choosing to treat patients according to their ability to recover. It arises from the use of prospective payment schemes in an asymmetry of information framework. In this context in fact the provider can observe some relevant information (freely or at a cost) before making its effort which will then be used to its own advantage. The paper studies the scope for these types of behaviour in a mixed market for hospital care where the hospitals do not share the same objectives. We show that in this context cream skimming is made possible by the presence of two important elements: the public hospital prefers to treat high severity patients and the regulator is unable to enforce hard budget constraint rules. The paper adds an important dimension to the study of cream skimming as proposed by the traditional literature where asymmetry of information alone is considered the cause of this market failure. In our context, in fact, cream skimming arises mainly from a regulatory failure.

Quality and Investment Decisions in Hospital Care when Physicians are Devoted Workers

This paper analyses the decision to invest in quality by a hospital in an environment where doctors are devoted workers, i.e. they care for specific aspects of the output they produce. We assume that quality is the result of both an investment in new technology and the effort of the medical staff. Hospital services are paid on the basis of their marginal cost of production while the number of patients treated depends on a purchasing rule which discriminates for the level and timing of the investment. We show that the presence of devoted doctors affects the trade-off between investment and the purchasing rule so that for the hospital it is not always optimal to anticipate the investment decision.Hospital technology, Devoted worker, Quality, Irreversible investment, Real options

ILR Research in Progress 2006-07

The production of scholarly research continues to be one of the primary missions of the ILR School. During a typical academic year, ILR faculty members published or had accepted for publication over 25 books, edited volumes, and monographs, 170 articles and chapters in edited volumes, numerous book reviews. In addition, a large number of manuscripts were submitted for publication, presented at professional association meetings, or circulated in working paper form. Our faculty's research continues to find its way into the very best industrial relations, social science and statistics journals.Research_in_Progress_2006_07.pdf: 18 downloads, before Oct. 1, 2020

Neural Substrates of Decision-Making in Economic Games

In economic experiments decisions often differ from game-theoretic predictions. Why are people generous in one-shot ultimatum games with strangers? Is there a benefit to generosity toward strangers? Research on the neural substrates of decisions suggests that some choices are hormone-dependent. By artificially stimulating subjects with neuroactive hormones, we can identify which hormones and brain regions participate in decisionmaking, to what degree and in what direction. Can a hormone make a person generous while another stingy? In this paper, two laboratory experiments are described using the hormones oxytocin (OT) and arginine vasopressin (AVP). Concentrations of these hormones in the brain continuously change in response to external stimuli. OT enhances trust (Michael Kosfeld et al. 2005b), reduce fear from strangers (C. Sue Carter 1998), and has anti-anxiety effects (Kerstin Uvnäs-Moberg, Maria Peterson 2005). AVP enhances attachment and bonding with kin in monogamous male mammals (Jennifer N. Ferguson et al. 2002) and increases reactive aggression (C. Sue Carter 2007). Dysfunctions of OT and/or AVP reception have been associated with autism (Miranda M. Lim et al. 2005). In Chapter One I review past experiments with the ultimatum (UG) and dictator (DG) games and visit some of the major results in the literature. In Chapter Two I present the results of my laboratory experiment where I examine why people are generous in one-shot economic games with strangers. I hypothesize that oxytocin would enhance generosity in the UG. Players in the OT group were much more generous than those in the placebo—OT offers in the UG were 80% higher than offers on placebo. Enhanced generosity was not due to altruism as there was no effect on DG offers. This implies that other-regarding preferences are at play in the amount of money sent but only in a reciprocal context. The third chapter presents an experiment on punishment. I hypothesized that AVP would increase rejections and stinginess in the UG and TG. Results show that AVP affects rejections and stinginess in small groups but not in large ones. Chapter Four contains the summary of future research suggestions.Oxytocin; Vasopressin; ultimatum game; dictator game; trust game; generosity; altruism

A game-based approach towards facilitating decision making for perishable products: an example of blood supply chain

NOTICE: this is the author’s version of a work that was accepted for publication in Expert Systems with Applications. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Expert Systems with Applications, Volume 41, Issue 9, July 2014, Pages 4043–4059 doi:10.1016/j.eswa.2013.12.038Supply chains for perishable items consist of products with a fixed shelf life and limited production/collection; managing them requires competent decision-making. With the objective of placing the learners in the position of decision-makers, we propose the Blood Supply Chain Game which simulates the supply chain of blood units from donors to patients based on a real case study modeling the UK blood supply chain. The Excel-based game is an abstraction of the technical complex simulation model providing a more appropriate learning environment. This paper presents the game’s background, its mathematical formulations, example teaching scenarios and the learners’ evaluation. The game aims to translate qualitative aspects of a sensitive supply chain into quantitative economic consequences by presenting a process analysis and suggesting solutions for the patient’s benefit in a cost effective manner, trying to synchronize blood demand and supply and maximize the value of the whole supply chain. This innovative approach will be instructive for students and healthcare service professionals

How specificity and presentation of data affect our rational decision-making ability, oriented to a pharmaceutical perspective.

This dissertation aims to show the influence of factors on our perception and consequent evaluation of data, respectively our assessment of situations. Furthermore, it deals with the question to what extent rationally abstracted processes are common in the medical-pharmaceutical field. Overall, this dissertation indicates that limited evidence of abstracted approaches in the medical-pharmaceutical context can be found. Furthermore it is shown that drug evaluations, in particular the risk evaluation( even in itself) , are subject to strong subjective factors that distort the results.Ziel dieser Arbeit ist es, den Einfluss von Faktoren auf unsere Wahrnehmung und die daraus resultierende Bewertung von Daten und Situationen aufzuzeigen. Ergänzend, inwieweit rationale abstrahierte Prozesse im medizinisch-pharmazeutischen Bereich üblich sind. Insgesamt zeigt die Dissertation, dass abstrahierende Ansätze im medizinisch-pharmazeutischen Kontext nur in begrenztem Umfang zu finden sind. Außerdem wird gezeigt, dass Arzneimittelbewertungen, insbesondere die Risikobewertung (auch an sich), starken subjektiven Faktoren unterliegen, die die Ergebnisse verzerren

Tripartite evolutionary game study on coordination information security in prescription circulation

To further reform the medical and health care system, regulating multi-level treatment and rationalizing the use of medicine, and securing prescription circulation information, this study explores the evolutionary behavior of three players in terms of information security collaboration under the prescription circulation policy, analyzes the evolutionary paths, and examines the influence of key parameters on evolutionary outcomes by constructing a tripartite evolutionary game model consisting of hospitals, retail pharmacies, and healthcare service platforms. The study shows the following: (1) When the information security costs of prescription circulation increase, the willingness of hospitals to promote information collaboration weakens, the probability of control and regulation by healthcare platforms will be enhanced, and the incentive for retail pharmacies to undertake prescription circulation increases and then decreases. (2) The increased profitability of prescription drug sales can cause a decrease in the likelihood of both parties working together to promote information security. Increasing the collaborative space between hospitals and retail pharmacies is conducive to improving information security in the circulation of prescriptions. (3) A bi-directional constraint relationship exists between the circulation and control subjects. The shorter the technology spillover time from the healthcare service platform is, the higher the probability that hospitals and retail pharmacies will maintain the security of prescription information. (4) In the early stages of prescription circulation, the external regulatory action of the healthcare service platform is essential to improve the coordination of information security. Finally, combined with the tripartite evolutionary game model and simulation analysis results, it offers countermeasures and suggestions for the government to realize the prescription circulation information security collaboration