The rapid development of mobile health technology (m-Health) provides unprecedented opportunities for improving health services. As the bridge between doctors and patients, mobile health applications enable patients to communicate with doctors through their smartphones, which is becoming more and more popular among people. To evaluate the influence of m-Health applications on the medical service market, we propose a medical service equilibrium model. The model can balance the supply of doctors and demand of patients and reflect possible options for both doctors and patients with or without m-Health applications in the medical service market. In the meantime, we analyze the behavior of patients and the activities of doctors to minimize patients’ full costs of healthcare and doctors’ futility. Then, we provide a resolution algorithm through mathematical reasoning. Lastly, based on artificially generated dataset, experiments are conducted to evaluate the medical services of m-Health applications.
1. Introduction Healthcare performs an important role in people’s health and life quality. Healthcare spending in China is increasing rapidly. The country’s annual expenditure is projected to grow at an average rate of 11.8 percent a year from 2014 to 2018, reaching $892 billion by 2018 . Despite these positive numbers, people still have to pay expensive costs when they go to hospitals for medical services. Besides, the people, especially for rural and remote area people who need medical services, have no alternative choice but travel to other cities to receive healthcare services and consultation. What is more, before consulting doctors, people may have to wait for a long time for diagnostic examinations. All of those will increase their commuting and waiting costs. In addition, many developing countries have a large population, while the medical staff are insufficient. For example, China only has 1.94 physicians and 0.83 health workers for every 1000 patients, far behind the Millennium Development Goal that every 1000 people need at least 2.5 medical staff for healthcare.  Because of the limited capacity and resources of the government and Information and Communication Technologies (ICT), the medical service system in China is unsound.
Meanwhile, technologies have been advanced to improve the medical services, such as telemedicine  and mobile health . Traditionally, patients always go to the doctors in hospital, which is not very convenient. This way can increase healthcare costs. Due to the advance of mobile and wireless communication technologies, people can receive medical services by their smartphones rather than having to go to hospitals. There are a total of 5 billion mobile phones in the world, of which more than 1.08 billion are smartphones. So, each of the 80% of the world population owns a smartphone . The number of smartphones will soar to 16.8 billion globally by 2019 . With the increase of mobile devices, various mobile health (m-Health) applications, such as MD, iTriage, UK’sNHS, Mayo Clinic’s Health App, and Spring Rain Doctor, have emerged in recent years. For example, Spring Rain Doctor, one main m-Health application in China, has reached 92 million users . Spring Rain Doctor is the largest mobile doctor-patient communication platform in the world. In the medical service market, patients have the need for recovery. They can consult doctors and get services, expecting to spend as little as possible. As service providers, doctors will naturally want to get more pay. Taking Spring Rain Doctor as an example, for patients, they can get quick consultation services wherever and whenever they need. They could know more about the disease and treatment measures as well. It can help patients reduce the costs of time, space, and money and prevent excessive medical treatment. For doctors, Spring Rain Doctor can help doctors fully utilize their fragmented time. The doctors can increase their income by the convenient Internet communication and establish personal brand. In the meantime, doctors can decrease misdiagnosis rate by adding big data system auxiliary outside of doctor-patient multidirectional interaction. As the bridge between doctors and patients, m-Health applications will have a major effect on people’s health.
The term m-Health was coined by Robert Istepanian as use of “emerging mobile communications and network technologies for healthcare” in 2005 . m-Health is a subarea of eHealth. People can use mobile phones or mobile telecom equipment to receive health services and information. But m-Health cannot replace e-Health . m-Health can help patients to receive health services using information and communication technologies. This convenient and efficient way can reduce treatment costs. The applications (apps) of m-Health can help people to change their unhealthy lifestyle and form good habits . Steinhubl et al.  provided a comprehensive review of the emerging field of mobile health and the challenges we faced. Recently, many smartphone-based m-Health applications have been developed for medical purposes. Sclafani et al.  conducted an investigation of mobile tablet and applications by email. Nearly half of tablet users said that they would use mobile tablet and applications to get health services. Based on fundamental features of m-Health for physical activity, Ayubi et al.  developed an m-Health application successfully. According to relevant literatures of m-Health platform’s benefits and standards, Whiteside  examined some m-Health applications. In order to deal with alert messages, Kafeza et al.  developed a model for mobile devices to receive medical task alerts. In order to investigate how to interconnect biomedical sensors in a wireless body area network, Bao et al.  proposed a novel solution to tackle the problem of entity authentication in body area sensor network (BASN) for m-Health. To overcome the scarcity of follow-up health services for cancer, Tiancheng et al.  designed a smartphone app framework. The framework can make risk assessment for the patient’s health condition and supervise the follow-up health services. After analyzing the usage characteristics of a mobile health application, Garibay et al.  found that the app named Heartkeeper was useful to improve the quality of medical services for patients. After exploring the benefits and challenges of health mobile apps for patients with type 2 diabetes, Peng et al.  provided the acceptability, feasibility, and effectiveness of mobile apps for patients’ compliance behavior, self-management, and self-care ability. After describing the use and acceptability of m-Health by patients with HIV/tuberculosis and healthcare providers, Hirsch-Moverman et al.  found that the m-Health intervention was a low-tech, user-friendly intervention. To promote the development of m-Health, Jones et al.  proposed a model-driven design and development methodology. From the above studies, we can see that all of the studies have illuminated the roles of m-Health applications including medical service reminders, arranger, recorder, transmitter, mentor, and intervener. These m-Health applications can improve patients’ life quality. However, none of the studies have estimated the effect of communication of m-Health application and the impact on patients and doctors with or without m-Health applications.
In fact, in many cities such as New York City and most cities in China, m-Health applications are widely adopted by doctors and patients. For example, a mobile health app is named My Medical™. Patients can store and send their medical records to doctors by pressing the button on it. And doctors also can give replies to patients by the app. Besides, doctors can communicate with patients by another app named Doximity, send secure HIPAA faxes, and follow information about their specialty . In China, Spring Rain Doctor  allows patients to communicate with doctors about their health issues directly by their telephones.
To estimate the impact of m-Health applications on these medical service markets, this paper proposes an equilibrium model. The model can balance the supply of doctors and demand of patients and reflect possible options of both doctors and patients with or without m-Health applications in the medical service market. Both doctors and patients have the right to use or not use the m-Health application and also have the right to accept or not accept each other. The earlier work by He and Shen  is adopted to describe the possible adoptions of both doctors and patients of the m-Health applications. The purpose of the patients is to minimize their own full costs of healthcare including the consultation fee and waiting and medical service time costs. Doctors can get as much pay as possible by minimizing their own futility.