This paper studies the capacity reallocation in a hierarchical medical ecosystem via sinking high-quality resource from high-level hospitals to low-level hospitals. To facilitate the capacity sinking, we develop two payment schemes: fee-for-capacity (FFC) and performance payment (PP). Under the FFC scheme, the low-level hospital always pays a unit capacity sinking price to the high-level hospital, whereas under the PP scheme, the reallocation price is paid contingent on the increased patient visits at the low-level hospital due to capacity sinking. By considering the profit- and utility-maximizing behaviors of strategic parties, we build a four-stage Stackelberg sequential game model within a queuing framework to derive the equilibrium results in terms of the low-level hospital’s capacity, the high-level hospital’s capacity sinking rate, and the funder’s capacity sinking price. In the absence of funder’s coordination, it is shown that any increase in sinking price always reduces the capacity sinking rate. In the presence of funder’s coordination, we find that: (1) the payment schemes under study will not alter the efficiency or coordination of the overall healthcare systems; (2) for the setting with a high perceived value by patients, under each payment scheme, the capacity sinking program is efficient to increase the high-level hospital’s profit and the social welfare as well, but it lowers the patient visit rate at the low-level hospital; (3) for the setting with a higher difference between the patients’ perceived values at the two levels of hospitals, the capacity sinking program is efficient to increase the patient visit rate at the low-level hospital and the social welfare as well, but it sacrifices the high-level hospital’s profit. Finally, numerical studies provide more useful managerial insights.

本文通过将高质量资源从高级医院转移到低级医院来研究分级医学生态系统中的容量重新分配。为了方便容量下沉，我们开发了两种付款方案：费-为-容量（FFC）和绩效工资（PP）。在FFC计划下，低级医院总是向高级医院支付单位下沉的价格，而在PP计划下，重新分配价格是根据能力的增加而取决于低级医院就诊人数的增加下沉。通过考虑战略方的利润最大化和效用最大化的行为，我们建立了一个四阶段的Stackelberg序列排队框架内的博弈模型，用于根据低级医院的容量，高级医院的容量下沉率和出资者的容量下沉价格得出均衡结果。在没有出资者的协调的情况下，事实证明，下沉价格的任何增加总是会降低容量下沉率。在出资者的协调下，我们发现：（1）所研究的支付计划不会改变整个医疗体系的效率或协调；（2）对于患者感知价值较高的环境，在每个支付方案下，容量下降该计划可以有效地提高高级医院的利润和社会福利，但会降低低级医院的患者就诊率；（3）对于两级医院的患者感知值差异较大的设置，能力下沉计划可以有效地提高低级医院的患者就诊率和社会福利，但是牺牲了高级医院的利润。最后，数值研究提供了更有用的管理见解。