Incentive-driven post-discharge compliance management for chronic disease patients in healthcare service operations

Abstract

Patients suffering from chronic diseases such as chronic obstructive pulmonary disorder (COPD), diabetes and hypertension exhibit poor compliance with the post-discharge treatment regimen, which results in high treatment costs and deteriorating health. Rampant noncompliance leads to unplanned hospital readmissions and imposes operational challenges for healthcare providers. This study aims to quantify the impact of noncompliance and to provide a framework to assist healthcare stakeholders in improving the overall well-being of patients through the most effective allocation of resources. We establish a game-theoretic model where patient lack of compliance is modeled by incorporating bounded rationality in the context of a congested service system. The model incorporates the heterogeneity of patients with respect to their sophistication and uncertainty regarding the severity of their conditions. The equilibrium compliance behavior of patients is obtained, which is affected by their present bias and the congestion they may face due to limited medical resources. It stresses the importance of improving compliance to reduce re-hospitalization. To this end, the optimal structure of monetary intervention that can elicit patient adherence at the least cost for an insurer is developed. It is suggested that insurers should subsidize early compliance behavior and raise the awareness of congestion to offset the present bias against complying in patients. The application of the model to incentivize adherence in COPD patients is discussed.

Keywords:

• Chronic disease
• compliance modeling
• game theory
• healthcare operations management
• present bias