What Promotes Medical Overuse: Perspective on Evolutionary Game between Administration and Medical Institutions

Area of Science:

• Health Economics
• Game Theory
• Public Policy

Background:

• Medical overuse significantly increases global healthcare expenditures.
• The National Healthcare Security Administration (NHSA) in China is pivotal in curbing medical overuse.
• Existing research often overlooks the strategic interactions between healthcare providers and regulatory bodies.

Purpose of the Study:

• To analyze the strategic interplay between the NHSA and medical institutions regarding medical overuse.
• To model the dynamic evolution of supervision and overuse behaviors.
• To identify conditions for effective and efficient NHSA supervision.

Main Methods:

• Development of an evolutionary game model based on bounded rationality.
• Analysis of stable evolutionary strategies.
• Numerical simulations and sensitivity experiments across various scenarios.

Main Results:

• Medical institutions adopt fixed strategies (overuse or appropriate use) when the profit gap from overuse is extreme (high or low).
• NHSA's strategy significantly influences medical institutions' behavior only when the profit gap is moderate.
• NHSA's strategic choices are influenced by the balance between medical use profits and supervision costs.

Conclusions:

• Understanding the profit gap is crucial for predicting medical institution behavior.
• Targeted NHSA intervention is most effective at moderate profit gaps.
• The findings offer theoretical support for optimizing NHSA supervision strategies to achieve efficient oversight without excessive effort.