Differentiated health insurance policy for coordinating healthcare referral in hierarchical healthcare systems with an internet diagnosis platform

Abstract

The integration of the Internet with traditional medical services is poised to transform health insurance policies. This study aims to explore the coordinating role of differentiated health insurance policies within the context of Internet healthcare. A four-stage sequential game decision-making model is developed within a queuing framework to address scenarios involving online patient referrals and misdiagnoses. The model begins by analyzing the equilibrium arrival strategy of patients, followed by the determination of optimal service capacity strategies for a nonprofit community health center (CHC) and optimal pricing strategies for a for-profit general hospital (GH). Additionally, the model describes an optimal differentiated subsidy strategy for the government aimed at minimizing total social costs. Analysis reveals that under certain conditions, an increase in the service price at GH relative to CHC can lead to a higher influx of online patients visiting GH in person. Furthermore, when the number of online patients exceeds a specific threshold, it not only prompts the government to increase the disparity in health insurance subsidies between the two hospital tiers but also encourages GH to reduce its service prices and offer free services to online patients. Numerical experiments explore the effects of government budgets, sharing ratios, and other variables on the system's equilibrium state, providing several managerial insights. Notably, when patients' misdiagnosis costs are partially covered, increasing GH's misdiagnosis cost-sharing ratio not only enhances the patient arrival rate but also enhances GH's profitability.