Evaluation of reverse referral partnership in a tiered hospital system – A queuing-based approach

Reverse referral implies referring patients from a comprehensive hospital to a community healthcare centre. In recent years, it has become popular for post-acute care in the tiered Chinese hospital system as it helps achieve more balanced utilisation between facilities at different levels. Nevertheless, it remains unclear how to implement the reverse referral partnership given the likely conflicting interests between the involved hospitals. In this paper, we evaluate a reversal referral partnership involving one hospital of each type, for which we develop queuing models for the two hospitals to capture multiple patient waits, services and transitions, with reverse referral in place. We use queuing-based performance outcomes to evaluate the profitability of each hospital and its willingness to join the partnership. We combine the above evaluations to further assess the partnership effectiveness. Through this work, we expect to provide policy insights to the government for forming hospital partnerships effectively.