Pareto Optimization for Hospital Alliance Reverse Referral Decision

Reverse referral strategy, i.e. transferring patients from the upper-level hospital (ULH) to the lower-level hospital (LLH) in the same Hospital Alliance, has been proposed to deal with the problem of inappropriate use of medical resource in health care systems. Despite these actions have brought some positive effects, the problem of making optimal decisions for the cooperating hospitals to enforce the reverse referral strategy at an operational level and how the cooperated hospitals will react to each other remains unclear. In this study, we consider a Hospital Alliance comprising an ULH and a LLH with reverse referral. We study how these cooperating hospitals can compromise with each other when both adopt a threshold control policy. The Pareto front and corresponding optimal control policies are obtained through multi-fidelity optimization.