Sustainability of Healthcare Information Exchanges: A Game-Theoretic Approach

Based on our interactions with the key personnel of three different healthcare information exchange (HIE) providers in Texas, we study a setting where the HIE provider can offer value-added services in addition to base HIE connectivity. We find that costs related to maintaining the HIE and offering value-added services affect whether the HIE network will be established or not, whereas heterogeneity among healthcare practitioners (HPs) influence the participation levels in these networks. We find that in different circumstances, low-gain HPs choose not to join to HIEs. Hence, in order to entice more participation in HIEs, it might be beneficial for the policy-makers and/or HIE providers to (i) establish a second HIE in the region, (ii) propose more value to the low-gain HPs, or (iii) offer and/or incentivize value-added services. Contrary to intuition, we also find that an increase in the highest benefit HPs can get from the HIE can even decrease the number of participating HPs in the HIE. Besides, since the amount of funds from the government and the other agencies often change and will eventually cease, we analyze how the changes in the benefit HPs obtain from the HIE affect (i) participation in the network, (ii) HIE subscription fee and the fee for value-added service, (iii) number of HPs that request value-added service, and (iv) the net values of the HIE provider and HPs. We also present several other insights and provide guidelines for the policy-makers that may help them improve the sustainability of HIEs and increase the participation levels in these networks.