Yu Zhihao, Sun Guangning, Lin Shuaijun, Hu Haoqian, Xu Jing
Faculty of Humanities and Social Sciences, Macao Polytechnic University, Macao, China.
Medical Department, Weifang Maternal and Child Health Hospital, Weifang, Shandong, China.
Cost Eff Resour Alloc. 2025 Mar 31;23(1):11. doi: 10.1186/s12962-025-00616-w.
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.
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.
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.
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.
在公立医院现行成本管理模式下，决策严重依赖管理者的主观判断，导致华东地区一家三级医院2020年成本超支率达12.9%。为解决医院成本控制实践中的系统性问题，本研究将基于博弈论组合赋权法的决策框架引入医院成本管理体系。该框架通过协调专家主观判断与客观数据离散度，旨在减轻医院成本控制中的主观偏差，解决现有公立医院成本控制策略顶层设计的不足，为公立医院提供更科学、系统的成本管理方法。
运用文献研究法和德尔菲法，为案例医院建立了专门的成本控制评价指标体系。采用层次分析法（AHP）和熵权法（EWM），分别确定各指标的主观权重和客观权重。然后运用基于博弈论的组合赋权法将这些权重进行融合。基于博弈论权重计算结果，设计了公立医院成本控制优化方案，并在案例医院实施了三年。最后，采用模糊综合评价法评估优化方案实施前后的改进效果。
研究表明，以往研究低估了后勤物资、公用经费（水、电、暖）和处置阶段等指标的重要性，而过度强调了人员经费、奖金和维修阶段。本研究相应地重新校准了指标权重并优化了策略。实施该方案三年后，案例医院在人员费用、材料成本、药品成本、管理费用和资本支出方面均有显著改善，总体满意度得分从79.5656提高到90.2492。值得注意的是，权重显著提高的领域改进最为显著，回报率更高。
在案例医院实施过程中，基于博弈论的组合赋权法在优化公立医院成本控制策略方面被证明是有效的。它有助于在成本管理薄弱环节进行更有针对性的干预，并有助于减少决策偏差。此外，该方法提高了成本控制的严谨性和效率，同时为医疗领域的决策提供了系统框架。
