The Mechanism of Doctor–Patient Trust in the Hierarchical Diagnosis and Treatment System (HDTS) From the Perspective of Tripartite Evolutionary Game

Abstract

Objective: Doctor–patient trust, especially patients’ trust in doctors, represents patients’ compliance with doctors’ behavior and may affect patients’ choice of medical treatment behavior. This paper aims to delve into the profound impact of doctor–patient trust on the hierarchical diagnosis and treatment system. Additionally, it formulates corresponding policy suggestions for reforming this system from a practical perspective, offering a useful reference for the development of both the theory and practice of China’s healthcare protections.

Methods: In this paper, the rank-dependent expected utility theory was used to construct a tripartite evolutionary game model of hierarchical diagnosis and treatment system for observing the interactions and behaviors between superior hospitals, primary hospitals, and patients under different levels of doctor–patient trust. Meanwhile, descriptive statistics and binary logistic regression methods were used in empirical research for revealing the specific mechanism.

Results: When the doctor–patient trust is at a high level, it is easier for each participant in the hierarchical diagnosis and treatment system to choose cooperative strategies, thus enabling the system to operate smoothly. Specifically, the medical level of healthcare institutions exerts a significantly positive impact on the level of doctor–patient trust and concurrently, an enhanced level of doctor–patient trust promotes patients’ adherence to the hierarchical diagnosis and treatment system when making healthcare choices.

Conclusions: Doctor–patient trust is a significant bridge connecting medical institutions and patients. It is an important factor to realize the orderly operation of hierarchical diagnosis and treatment system. To attain the objective of strengthening doctor–patient trust and fostering the smooth functioning of the hierarchical diagnosis and treatment system, it is essential to capitalize on policy mechanism to motivate healthcare service providers to enhance their medical capabilities and gradually guide patients to make healthcare choices in an orderly manner according to the system design.