Reverse Referral Decisions for Telemedicine-Based Healthcare Alliance Considering Patient Online Choice Behavior

Abstract

To address the disparities between medical resources and patient needs in large general hospitals (GHs), this study examines the coordination of referral processes between GH and community health centers (CHCs) enabled by telemedicine-based online service channels used by GH as gatekeepers. A three-stage game model is developed within a queuing theory framework to investigate the dynamic decision-making interactions among patients, CHC, and GH. The equilibrium decisions are given concerning the arrival rates of both initial offline and online patients, the service capacity of CHC, and the referral threshold of GH. The analysis compares system performance under partial and full referral scenarios. The findings reveal a counterintuitive result: Partial reverse referral from online services may prompt the CHC to reduce its service capacity for profit-seeking purposes, thereby diminishing patient welfare. Numerical experiments indicate that the online reverse referral mechanism is effective when the scale of online patients is sufficiently large. When patient scale is inadequate, the CHC, lacking profit margins, tends to withdraw from the referral system. Moreover, under conditions of expanded GH service capacity, partial reverse referral outperforms full reverse referral in improving overall system efficiency.