基于动态博弈的远程医疗政策与患者社会福利研究

为了研究远程医疗的有效政策以及政策对患者社会福利的影响,考虑一个由政府、医院和患者三个主要利益相关者构成的医疗系统,利用动态博弈等理论建立了三种博弈模型：完全竞争条件下的两阶段动态博弈模型、医保报销比例政策下的三阶段动态博弈模型、医保报销比例和医疗服务价格限制双重政策下的三阶段动态博弈模型。研究结果表明,患者社会福利在完全竞争博弈中最低,在医保报销比例政策下的博弈中次之,在医保报销比例和医疗服务价格限制双重政策规制的博弈中最高。将远程医疗纳入医保范围,并给予较高的医保报销比例,既有利于远程医疗市场占有量的增长,又有利于患者社会福利的增加。但较高的医保报销比例会使远程医疗和传统医疗服务价格都显著上涨,必须施加医疗服务价格限制,以控制价格的上涨,减少社会医疗成本。最后,算例和敏感性分析验证了模型的有效性和正确性。     

Health care applications of complexity science. Life at the edge of chaos

The authors explore complexity science, a relatively new field of inquiry, which holds for both clinicians and health care leaders the real possibility of stimulating fresh insights and approaches to health and medical care-both its provision and its organization. Two case studies are presented to illustrate how complexity theory can provide health care leaders with a new perspective on how to address the myriad challenges they confront daily: (1) a patient with dissociative identity disorder; and (2) a physician task group charged to advise on hospital medical staff reorganization and governance. These case studies help clinicians and leaders of health care organizations understand how complexity: (1) may be relevant, even helpful, as they consider difficult challenges in both patient and organizational management; and (2) might emerge as a synthesizing force as they face the extraordinarily complicated task of jointly creating integrated health care systems. A resource section is provided for those who may wish to further pursue the topic.     

The problem of the last bed: Contextualization and a new simulation framework for analyzing physician decisions

Faced with a full Intensive Care Unit (ICU), physicians need to decide between turning away a new patient in need of critical care and creating a vacancy by prematurely discharging a current occupant. This dilemma is widely discussed in the medical literature, where the influencing factors are identified, the patient discharge process described and the patient health consequences analyzed. Nevertheless, the existing mathematical models of ICU management practices overlook many of the factors considered by physicians in real-world triage decisions.This paper offers a review of the medical and mathematical literature on patient discharge decisions, and a proposal for a new simulation framework to enable more realistic mathematical modeling of the real-world patient discharge process. Our model includes a) the times at which discharge decisions are made and setup times for patient transfer from the ICU to a general ward and preparation of an ICU bed for an incoming patient, in order to capture the impossibility of an immediate switch of patients; b) advance notice of the number of patients due to arrive from elective surgery requiring intensive postoperative care and potentially triggering the need for early discharges to avoid surgery cancelations; and c) patient health status (to reflect the dependency of physicians’ discharge decisions on health indicators) by modeling length of stay with a phase-type distribution in which a medical meaning is assigned to each state.A simulation-based optimization method is also proposed as a means to obtain optimal discharge decisions as a function of the health status of current patients, the bed occupancy level and the number of planned arrivals from elective surgery over the following days. Optimal decisions should strike a balance between patient rejection and LoS reduction.This new simulation framework generates an optimal discharge policy, which closely resembles real decision-making under a cautious discharge policy, where the frequency of early discharge increases with the ICU occupancy level. This is a contrast with previous simulation models, which consider only the triage of the last bed, disregarding the pressures on physicians faced with high bed occupancy levels.     

USING MANAGEMENT GAMES AS AN AID IN TEACHING MIS DESIGN

As an approach to teaching management information systems, students are required to play a management game. The students become aware of information needs through participation in the decision process of the game. The student then develops an integrated system to assist in playing this management game. This new approach, the gaming method, is considered an effective way of teaching integrated systems because the intimate interrelationships between decision-making processes and information systems can be easily illustrated.     

医生的信息-情感交互模式对移动问诊服务满意度的影响——基于“激励-保健”理论的分析

移动问诊服务日益成熟,但患者满意度仍有待提高。现有研究对医患交互过程关注不足,且忽略患者不满意评价的影响因素。为此,本文引入"激励-保健"理论视角,研究医生的信息-情感交互模式对移动问诊服务满意及不满的影响机制。本文筛选国内某领先移动问诊平台中的300次医患沟通记录,采用"先定性后定量"的混合研究方法对数据进行分析。其中,定性研究旨在识别医生交互模式的细分维度,定量研究则用于提出并验证不同交互模式与患者满意及不满的关系。研究发现,医生的信息交互模式是移动问诊服务满意度的保健因素,而情感交互模式是激励因素。结论丰富了移动问诊服务患者满意度的研究框架,对改善医生行为和医疗服务APP设计提供了指导。     

A journey around decision-making: Searching for the “big picture” across disciplines

This paper carries out an interdisciplinary literature review to develop an updated framework that integrates all aspects of decision-making. It proposes a framework that combines the evolutionary perspective with the complexity theory to integrate the ontological communalities between the examined disciplines (operational research, psychology and management). Decision-making is regarded as a systemic, multi-tiered information-based process, founded on the interaction of the decision-maker with the environment in a sort of learning path which co-evolves through variation–selection–retention mechanisms nourished by environmental feedback.Such a complex-coevolutionary perspective provides valuable insights concerning some as-yet-unexplored aspects of decision-making, such as inter- and intra-individual differences in decision-making, as well as the interaction of ‘rational’ and ‘intuitive’ processes or some contradictory evidence (regarding ‘fractionated expertise’ and ‘escalation of commitment’).Practical implications on management education are highlighted, as well as methodological limitations and needs for further studies. The journey is not yet over and probably never will be, but, from an evolutionary perspective, it is the journey, not the arrival, that matters.     

Changing bonuses and the resulting effects of employees’ incentives to an inspection game

The following paper analyses an intraorganizational conflict in materials management between a manager, a controller and the company management. By using a game theoretic approach, this paper especially seeks to answer the question: ‘Do bonuses change employees’ incentives when the focus is directed at the control level of company management?’ This analysis is based upon an application of a three-person inspection game. Within the three-person game a partial influence of a variation of penalties and bonuses is measured analytically. A simultaneous variation of the bonuses for the subordinated players, as the incentive effect to guarantee rational behaviour, is presented here as a simulation. While different intervals of bonus values, which also affect the payoff of the company management, and their influence on the equilibrium probabilities are examined, it becomes apparent that bonuses are able to neutralize each other in their effect on improved decision-making behaviours of the manager (inspectee) and the controller (inspector). But also a diverse variation leads to positive and negative effects on the manager’s behaviour.     

技术驱动的管理科学与工程研究

科技创新引领技术变革，加速变革的科技正在重塑世界政治、经济和社会发展的新格局、新形势。一系列新场景、新环境下的管理决策问题，如新一代移动通讯、人工智能、物联网、轨道交通与建筑工程、医疗工程、能源环境工程等，开启了管理科学与工程学科研究的新局面，并提出了全新的要求和挑战。本文通过系统梳理和总结相关文献和课题项目，阐述管理科学与工程领域的关键技术发展态势，并结合领域权威专家的问卷和访谈结果，立足新技术融合和新产业应用两个方面概括了技术驱动下管理科学与工程的主要研究方向。     

“互联网+医疗健康”背景下考虑患者反馈机制的药品质量监管策略研究

药品质量关乎公众生命健康、国民经济发展、社会稳定和国家安全，一直以来都是政府和全社会关注的热点问题之一。"互联网+医疗健康"背景下药品流通速度加快使得药品安全问题影响范围扩大，因此，建立患者反馈机制是促进互联网药品质量监管的有效方式。考虑患者反馈机制下如何设计互联网药品质量监管策略的问题，基于演化博弈理论，构建了政府部门、药品生产商、医药电商和患者参与的药品质量监管四方演化博弈模型，通过分析各博弈主体策略选择的稳定性，并基于Lyapunov第一法则对复制动态系统十六种均衡点进行稳定性分析，研究了促进药品生产商提供高质量药品的政府监管策略和患者反馈机制，并利用Matlab 2017仿真分析了各关键要素对策略演化的影响。研究结果表明：1）患者倾向于失真评价或投诉率较低时，医药电商更倾向于选择药品质量不检测，不利于互联网药品质量安全；2）患者失真评价下，不存在药品生产商提供高质量药品的稳定策略组合，而真实评价下有效的反馈机制和监管机制可使互联网药品质量安全具有稳定性；3）提高患者评价（正面评价或负面评价）带给医药电商和药品生产商的声誉价值增加或声誉损失，将会使药品生产商选择提供高质量药品做为稳定策略；4）降低患者失真评价和投诉维权行为的增加，均可增强药品生产商提供高质量药品的稳健性。最后，结合演化博弈模型和仿真分析结果，为完善药品质量监管机制提出了对策与建议。     

Aristotle's fallacy: A hypergame in the oil shipping business …

In this paper, an attempt is made to illustrate and validate some predictions of the ‘hypergame’ model of decision-making, a generalisation of the conventional game model as first described by von Neumann and Morgenstern. The hypergame concept, which can take players' differing perceptions, misperceptions and information conditions into account, is formally defined and two simple criteria of stability and choice are given. The core of the article consists of a case study involving decision-making under misperceptions. One result of the analysis is to show that decisions which at first sight appear ‘stupid’ and remain ‘irrational’ in a conventional game model, are indeed ‘rational’ if the players' perceptual limitations and their differing information conditions are considered. The conclusion is that the hypergame can be a useful extension of the traditional theory of games, and as such is one step on the way toward conceptually more complex and ‘realistic’ model building.     

Job-related diversity: the comprehensiveness and speed of board decision-making processes—an upper echelons approach

Strategic decision-making processes influence firm-level outcomes. Using the theory of upper echelons, this study investigates how diversity in directors’ skills, knowledge, and industry experience influence board decision-making processes that may impact overall strategic decision-making processes. Such diversity has been commonly accepted to be a ‘double-edged sword’—enhancing comprehensiveness but hindering the speed of decision-making. On the contrary, we used an existing large survey database to show that directors’ diverse educational background, functional background, and industry experience (job-related diversity) have a positive effect on comprehensiveness as well as the speed of board decision-making. In addition, our results indicate that board processes (directors’ use of their knowledge and skills) play an important role by transmitting the positive effects of diversity. The study is in a tradition of exploring how boards may influence firms’ strategic decision-making processes. Our findings provide additional arguments for adding job-related diversity to boards of directors.     

Coalitions of Actors and Managerial Innovations in the Healthcare and Social Healthcare Sector

This paper studies the behavior of a variety of stakeholders around the adoption of managerial innovations desired by operational managers of health services institutions. We show that if the operational manager may cause the managerial innovation, the tool prospective is subject to power games around coalitions of actors. The study of several management situations in health services institutions enables us, using the game theory, to highlight the “winning”, “losing” and “uncertain” coalitions that can achieve operational management within the establishment to settle a managerial innovation.     

Re-forming the traditional organization medical staff

The traditional, two-bylaws-model organized medical staff was created in another age (1919) to serve a simple health care system, controlled by physicians, in which the only players were patients, doctors, nurses, and small hospitals. This medical staff model does not meet the needs of the U.S. health care system of the 1990s. The purpose of this article is to provide the physician executive with a resource to use when he or she is called on to help determine what, if any, changes are needed in his or her organization to make the role of physician leaders more effective. Finding the right answer to this question is part of discovering ways to reduce health care costs without reducing the funds available to pay for direct delivery of health care services. Maintaining traditional, bureaucratic, legalistic organized medical staff activities is a very expensive game that we can no longer afford to play.     

需求不确定下生产能力与竞争优势之间的关系

在需求不确定的条件下,用生产能力刻画产量决策的柔性,用古诺模型描述企业间的(产量)竞争,建立一个两企业战略竞争博弈模型,并利用博弈均衡构建柔性水平与竞争优势之间的函数关系。比较静态分析结果表明,(1)其他条件不变,一家企业的相对竞争优势随着自己的生产能力增加而增加,但随着对手的生产能力增加而降低;(2)生产能力较高的企业将获得较高的绝对竞争优势。这些结果暗示,柔性水平与竞争优势之间呈现一种正向的变动关系。这一结论一方面在一定程度上澄清了战略管理文献中呈现出的"战略柔性与竞争优势之间的联系方向模凌两可"这一问题;另一方面,由于引入了竞争性战略互动,从而将基于个人理性决策的结果扩展到战略相互依赖的竞争性情形下。     

竞争性网络间的互联互通问题分析

竞争性网络的运营商基于自身利益可能拒绝互通或合谋相互征收高额接入费,这两种行为都将损害消费者福利,因而需要政府规制。本文在考虑网络外部性、运营商的市场份额、市场容量和用户的转换成本等因素影响的基础上,通过构建一个包含"防降价均衡"机制的三阶段博弈模型来分析运营商的服务定价、互通决策、政府的接入费规制决策以及社会福利变化,发现存在合理的接入费区间使得运营商有动力互通且社会福利得到改善。     

非合作博弈两阶段生产系统的环境效率评价

本文研究了环境效率评价中广泛存在的一类典型问题:两阶段非合作博弈的效率评价问题,该问题有两个明显的特点:(1)决策单元由经济生产子系统和污染物处理子系统两个阶段的子系统构成,(2)经济生产子系统产生的污染物由污染物处理子系统进行处理,且经济生产子系统居于主导地位,而污染物处理子系统居于从属地位.文章在分析各个决策单元整体效率与其子系统效率之间关系的基础上,提出一种能够同时评价决策单元整体效率和其子系统效率的DEA方法;然后引入非合作博弈思想,提出了基于两阶段非合作博弈的环境效率评价的DEA方法;最后采用中国各地区的工业系统的环境效率评价的实例分析说明了该方法的合理性和有效性.由于文章提出的方法能够有效地分析决策单元内部子系统的有效性水平,能够反映子系统之间的主从关系,能够发掘影响决策单元效率的关键因素,因而能够给出更为有效的环境管理信息,为决策者的决策提供科学的依据.     

Doing something about the weather

Recent developments in weather forecasting have created the potential for the operations research and management science (OR/MS) community to have a tremendous impact in distilling weather information into valuable decision tools. Weather-sensitive applications include transport, electric utilities, agriculture, and public emergency management. This article surveys existing research and practice using OR/MS tools to integrate weather forecasts in decision-making. Because the conditions that created the potential for OR/MS contributions—in particular an explosion in the amount of relevant forecast data—are quite recent, the amount of existing OR/MS work is modest. This article also describes promising but unexplored research opportunities for the OR/MS community.     

Management illusions and biases: Their impact on strategic decisions

Strategic decision-making often involves a great deal of uncertainty and ambiguity. Because managers are subject to ‘bounded rationality’ their cognitive processes may result in systematic decision biases. This paper summarizes research in the areas of cognitive psychology and behavioural decision theory dealing with human cognitive biases which may influence strategic decision-making. Examples of the probable operation of these biases in strategy formulation are given and conjectures about specific decision errors resulting from the biases are offered.     

Overconfidence and risk seeking in credit markets: an experimental game

Behavioral biases may influence bank decisions when granting credit to their customers. This paper explores this possibility in an experimental setting, contributing to the literature in two ways. First, we designed a business simulation game that replicates the basic decision-making processes of a bank granting credit to clients under conditions of risk and uncertainty. Second, we implemented a series of short tests to measure participants’ overconfidence and risk profile according to prospect theory and then conduct an experimental implementation of the simulation game. We find that higher levels of overprecision and risk seeking for gains (mostly attributable to distortion of probabilities) foster lower prices and higher volumes of credit, and reduce quality. The most consistent result is that distortion of probabilities affects the ability to discriminate between the quality of borrowers according to objective information, fostering strategies of lower loan prices to lower quality clients. The external validity of the results is also discussed.