Referral coordination mechanism for the hierarchical system with Internet diagnosis platform

Jingyang Wang; Xiaoyu Wang; Miao Yu; Dandan Yu; Jingyang Wang; Xiaoyu Wang; Miao Yu; Dandan Yu

doi:10.3934/jimo.2026053

Journal of Industrial and Management Optimization

2026, Volume 22, Issue 3: 1440-1463. doi: 10.3934/jimo.2026053

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Research article

Referral coordination mechanism for the hierarchical system with Internet diagnosis platform

1.
Information Science and Engineering School, Northeastern University, Shenyang, China
2.
School of Management, Shenyang Jianzhu University, Shenyang, China
3.
Information Center, The First Affiliated Hospital of Dalian Medical University, Dalian, China

Received: 19 September 2025 Revised: 26 January 2026 Accepted: 29 January 2026 Published: 27 February 2026
90B22, 91A80, 90B50

This paper explores referral coordination within a hierarchical healthcare system utilizing an Internet diagnosis platform. A reverse referral game model is established between a general hospital (GH) and community hospital(s) (CH). First, two system types are analyzed: a noncompetitive system consisting of a GH and a CH, and a competitive system consisting of a GH and multiple CHs. Using a queueing game framework, we derive optimal referral strategies under centralized decision-making. We further characterize optimal contracting mechanisms under two scenarios: an outsourcing arrangement where the GH sets prices to achieve perfect coordination, and a decentralized setting where both parties maximize individual profits (imperfect coordination). Comparing coordination efficiency across systems reveals that outsourcing mechanisms achieve perfect coordination in both configurations.Under imperfect coordination, while the noncompetitive system exhibits marginally higher coordination efficiency, the competitive system yields significantly higher treatment thresholds and GH profits.Thus, competition in referral systems with Internet diagnosis platforms enhances resource utilization and substantially increases GH profitability.
- coordination,
- mechanism design,
- hierarchical system,
- Internet diagnosis platform
Citation: Jingyang Wang, Xiaoyu Wang, Miao Yu, Dandan Yu. Referral coordination mechanism for the hierarchical system with Internet diagnosis platform[J]. Journal of Industrial and Management Optimization, 2026, 22(3): 1440-1463. doi: 10.3934/jimo.2026053

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Abstract

This paper explores referral coordination within a hierarchical healthcare system utilizing an Internet diagnosis platform. A reverse referral game model is established between a general hospital (GH) and community hospital(s) (CH). First, two system types are analyzed: a noncompetitive system consisting of a GH and a CH, and a competitive system consisting of a GH and multiple CHs. Using a queueing game framework, we derive optimal referral strategies under centralized decision-making. We further characterize optimal contracting mechanisms under two scenarios: an outsourcing arrangement where the GH sets prices to achieve perfect coordination, and a decentralized setting where both parties maximize individual profits (imperfect coordination). Comparing coordination efficiency across systems reveals that outsourcing mechanisms achieve perfect coordination in both configurations.Under imperfect coordination, while the noncompetitive system exhibits marginally higher coordination efficiency, the competitive system yields significantly higher treatment thresholds and GH profits.Thus, competition in referral systems with Internet diagnosis platforms enhances resource utilization and substantially increases GH profitability.

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