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Public and Private Healthcare Coordination: An Analysis of Contract Mechanisms based on Subsidy Payments
Computers & Industrial Engineering ( IF 6.7 ) Pub Date : 2020-08-01 , DOI: 10.1016/j.cie.2020.106526
Onur Kaya , Aydin Teymourifar , Gurkan Ozturk

Abstract Many healthcare systems are composed of public and private hospitals with different features. In public hospitals, patients generally obtain service at very low prices but there exist high waiting times and lower quality service. Whereas in private ones, although the prices are much higher, the waiting times are low and the level of quality perceived by the patients is high. It is observed that most of the patients prefer to go to the public hospital, mainly because of high prices in private hospitals. This causes overcrowding in public hospitals, while private hospitals are seen to be under-utilized and have excess capacity. The aim of this study is to suggest new contract mechanisms based on pricing and subsidy policies, that can be offered by the government to private hospitals in order to design a more balanced and efficient healthcare system for society. We develop a novel analytical model for patients’ preference between public and private hospitals and present different contract mechanisms based on this model. We determine the optimal parameters of the contracts and compare the results based on their effects on the healthcare system. Numerical results demonstrate that the proposed contract mechanisms can increase the total social utility significantly. In particular, when a contract mechanism based on differentiated subsidy payments is utilized, the expected waiting times in the system can be decreased and higher quality service can be obtained by the society in general without a significant increase in government expenditures.

中文翻译:

公私医疗协调:基于补贴支付的合同机制分析

摘要 许多医疗保健系统由具有不同特点的公立和私立医院组成。在公立医院,患者通常以极低的价格获得服务,但存在等待时间长和服务质量低的问题。而在私人医院,虽然价格要高得多,但等待时间很短,患者感知的质量水平很高。据观察,大多数患者更愿意去公立医院,主要是因为私立医院的价格高。这导致公立医院人满为患,而私立医院则被视为利用率不足且产能过剩。本研究的目的是提出基于定价和补贴政策的新合同机制,政府可以提供给私立医院,以便为社会设计一个更加平衡和高效的医疗保健系统。我们为患者在公立和私立医院之间的偏好开发了一种新的分析模型,并基于该模型提出了不同的合同机制。我们确定合同的最佳参数,并根据它们对医疗保健系统的影响来比较结果。数值结果表明,所提出的契约机制可以显着提高总社会效用。尤其是当采用差异化补贴支付的合同机制时,可以减少系统中的预期等待时间,在不显着增加政府支出的情况下,可以使社会普遍获得更高质量的服务。我们为患者在公立和私立医院之间的偏好开发了一种新的分析模型,并基于该模型提出了不同的合同机制。我们确定合同的最佳参数,并根据它们对医疗保健系统的影响来比较结果。数值结果表明,所提出的契约机制可以显着提高总社会效用。尤其是当采用差异化补贴支付的合同机制时,可以减少系统中的预期等待时间,在不显着增加政府支出的情况下,可以使社会普遍获得更高质量的服务。我们为患者在公立和私立医院之间的偏好开发了一种新的分析模型,并基于该模型提出了不同的合同机制。我们确定合同的最佳参数,并根据它们对医疗保健系统的影响来比较结果。数值结果表明,所提出的契约机制可以显着提高总社会效用。尤其是当采用差异化补贴支付的合同机制时,可以减少系统中的预期等待时间,在不显着增加政府支出的情况下,可以使社会普遍获得更高质量的服务。我们确定合同的最佳参数,并根据它们对医疗保健系统的影响来比较结果。数值结果表明,所提出的契约机制可以显着提高总社会效用。尤其是当采用差异化补贴支付的合同机制时,可以减少系统中的预期等待时间,在不显着增加政府支出的情况下,可以使社会普遍获得更高质量的服务。我们确定合同的最佳参数,并根据它们对医疗保健系统的影响来比较结果。数值结果表明,所提出的契约机制可以显着提高总社会效用。尤其是当采用差异化补贴支付的合同机制时,可以减少系统中的预期等待时间,在不显着增加政府支出的情况下,可以使社会普遍获得更高质量的服务。
更新日期:2020-08-01
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