Operationalizing game-theoretic weighting in public hospital cost control: an implementation framework from Chinese tertiary hospitals.

Objective: In the current cost management model of public hospitals, decision-making heavily relies on the subjective judgment of managers, resulting in a 12.9% cost overrun compared to the budget in 2020 at a tertiary hospital in Eastern China. To address the systemic issues in the hospital's cost control practices, this study introduced a decision-making framework based on the Game-Theoretic combination weighting method into the hospital's cost management system. By harmonizing expert subjective judgments with objective data dispersion, the framework aims to mitigate subjective biases in hospital cost control, address deficiencies in the top-level design of existing public hospital cost control strategies, and provide a more scientific and systematic cost management approach for public hospitals.

Method: Utilizing a literature review and the Delphi method, we established a Cost Control Evaluation Index System specifically tailored for the case hospitals. By employing the Analytic Hierarchy Process (AHP) and the Entropy Weight Method (EWM), we discerned subjective and objective weights for each index. These weights were then amalgamated using a game theory-based combined weighting method. Based on the calculations of weighting in game theory, a cost control optimization scheme for public hospitals was designed and implemented in the case hospital for a duration of three years. Ultimately, the improvement effects before and after the implementation of the optimization scheme were assessed using the fuzzy comprehensive evaluation method.

Results: Research indicates previous studies underestimated the importance of indicators such as Logistics Supplies, Utilities (Water, Electricity, Heating), and Disposal Phase, while overemphasizing Salaries, Bonuses, and Maintenance Phase. This study recalibrated indicator weights and optimized strategies accordingly. Three years after implementing this plan, the case hospital demonstrated significant improvements in personnel expenses, material costs, drug costs, administrative expenses, and capital expenditures, with its overall satisfaction score increasing from 79.5656 to 90.2492. Notably, the most substantial improvements occurred in areas where weights were significantly increased, yielding higher returns.

Conclusion: During the implementation at the case hospital, the game theory-based combined weighting method proved effective in optimizing cost control strategies for public hospitals. It facilitated more targeted interventions in weak areas of cost management and helped reduce decision-making biases. Additionally, this method enhanced the rigor and efficiency of cost control while providing a systematic framework to support decision-making in the medical field.