Collaborative Governance Strategies for Fever Clinics: A Multi-Scenario Evolutionary Game Analysis.

Abstract

Purpose: China's fever clinics succeeded during the Coronavirus Disease 2019 pandemic but revealed operational deficiencies. This study explores multiparty coordination mechanisms in fever clinics to improve collaborative management and efficiency in epidemic control.

Patients and methods: A tripartite evolutionary game model was constructed, involving "primary healthcare institutions-non-primary healthcare institutions-government" to analyze the evolutionary stable strategies among these entities in different scenarios. We implemented a simulation of evolutionary processes and conducted sensitivity analyses of government subsidies, punishments, and public supervision.

Results: Four evolutionarily stable strategies were identified: B₄(0,0,1), B₅(1,1,0), B₆(1,0,1), and B₇(0,1,1). The government gradually tended to be passive in emergency scenarios of the epidemic during the evolution process. Primary and non-primary healthcare institutions chose to participate in the coordinated response for epidemic prevention and control in transition scenarios. In addition, increased government subsidies and punishments resulted in the active participation of primary and non-primary healthcare institutions in the coordinated response for epidemic prevention and control. However, excessive subsidies and punishments led to lenient supervision when they exceeded a certain threshold. Meanwhile, the collaborative participation of non-primary healthcare institutions fluctuates in response to variations in government supervision. Under normal scenarios, public supervision had an obvious effect on driving primary healthcare institutions to participate in coordinated responses for epidemic prevention and control, thereby sharing the role of government supervision to a certain extent.

Conclusion: Government subsidies and punishments under a certain threshold effectively promoted the participation of primary and non-primary healthcare institutions in pandemic prevention and control. Additionally, participation in public supervision gradually increased with the gradual evolution of the pandemic. Therefore, our results suggested that the government should actively explore reasonable, dynamic thresholds for subsidies and punishments, promote public participation through diversified means, and explore diverse operation types of fever clinics to address the challenges of emerging infectious diseases in the future.