As the world continued to grapple with the COVID-19 pandemic, it became increasingly evident that we needed more healthcare professionals to ensure adequate care for those affected by the virus. One way to address this issue was by promoting healthcare skill development programs among the youth. In Gujarat, India, during the second wave of COVID-19, I applied game theory to design a health care intervention that encouraged households to send their children to study the General Duty Assistant (GDA) Health Care skill development program. This article will detail how I used game theory and present a tabular format outlining the strategies and outcomes.
What is Game Theory?
Game theory is a mathematical framework that is used to model decision-making in strategic situations where the outcome of one's choice depends on the choices of others. In health care, game theory can be applied to understand the behavior of households and students to encourage enrollment in health care skill development programs. The following table outlines how game theory can be applied to promote enrollment in the GDA Health Care skill development program.
Applying Game Theory to promote healthcare skill development
In practice, the application of game theory in designing health care interventions requires a thorough understanding of the local context. This includes understanding the incentives and motivations of households and students, the availability and quality of health care services, and the current state of the pandemic.
Village Level Change
The following stages below outlines the strategies and outcomes of the intervention if you choose to focus on village level change and intervention:
Stage 1: Prisoner's Dilemma
In the context of encouraging households to enroll their children in the GDA program, we can think of a scenario where two households are faced with the decision to enroll their child or not. If both households enroll their child, they both benefit from improved healthcare services in the community. However, if one household enrolls their child and the other does not, the household that does not enroll their child may receive the same level of healthcare services without having to bear the cost of enrollment. This creates a situation of a prisoner's dilemma.
Household Strategy / Household Strategy | Enrollment | No Enrollment |
Enrollment | Both households benefit from improved healthcare services | Enrolled household bears the cost of enrollment and both households benefit from improved healthcare services |
No Enrollment | Enrolled household bears the cost of enrollment and both households benefit from improved healthcare services | No household benefits from improved healthcare services |
Stage 2: Coordination Game
Once a critical mass of households have enrolled their children in the GDA program, the focus shifts to coordinating the efforts of the households and the program participants to provide improved healthcare services in the community.
Household Strategy / Participant Strategy | Coordinate Efforts | Do Not Coordinate Efforts |
Coordinate Efforts | Improved healthcare services in the community and better job for participants | No improvement in healthcare services but better job for participant in coordinating household. |
Do Not Coordinate Efforts | No improvement in healthcare services but better job for participant in coordinating household. | No improvement in healthcare services and no better jobs for any participants. |
Stage 3: Public Goods Game
In this stage, we can think of the healthcare services provided in the community as a public good that is available to all community members, regardless of whether they have enrolled their child in the GDA program or not. This creates a scenario of a public goods game.
Household Strategy / Household Strategy | Contribute | Don't Contribute |
Contribute | Improved healthcare services for all community members | Non-contributing household still benefits from improved healthcare services, while contributing household bears the cost of contribution |
Don't Contribute | Non-contributing household still benefits from improved healthcare services, while contributing household bears the cost of contribution | No household receives any benefits for improved healthcare services. |
Stage 4: Nash Equilibrium
At the final stage, we can use the concept of Nash equilibrium to identify a stable outcome where no household or participant can improve their outcome by changing their strategy, assuming that all other parties continue with their current strategies.
Household Strategy / Participant Strategy | Coordinate Efforts | Do Not Coordinate Efforts |
Both Contribute | Enrolled households and program participants coordinate efforts to provide improved healthcare services in the community. All community members benefit from the improved healthcare services. However, enrolled households bear the cost of enrollment and contribution. | Non-enrolled households benefit from the improved healthcare services without bearing the cost of enrollment and contribution, while enrolled households bear the cost of enrollment and contribution. Program participants may also bear the cost of coordination. |
One Contributes, One Does Not | The contributing household bears the cost of contribution, but the non-contributing household still benefits from the improved healthcare services. Program participants may also bear the cost of coordination. | The non-contributing household still benefits from the improved healthcare services, but the contributing household does not bear the cost of contribution. Program participants may also not be able to effectively coordinate efforts due to the lack of participation. |
In this table, the Nash equilibrium is highlighted in the first row and first column, where both households contribute to the efforts of the program participants to provide improved healthcare services in the community. This outcome is stable because neither household can improve their outcome by changing their strategy, assuming that the other household and program participants continue with their current strategies. However, this outcome requires both households to bear the cost of enrollment and contribution, while the non-enrolled households still benefit from the improved healthcare services without bearing any cost. The program participants may also bear the cost of coordination.
This also highlights the limitations of game theory in addressing issues of fairness and equity in resource allocation at macro-economic level, which may require additional interventions beyond the framework of game theory.
Participant-Programme Level Change: A better strategy based on free program enrollment
Stage | Game Theory Application | Description | Outcome |
Stage 1 | Iterated Prisoner's Dilemma | Provide free training to enrolled students | Encouraged households to enroll their children in the program |
Stage 2 | Coordination Game | Create a social network of students in the program | Encouraged peer support and increased enrollment |
Stage 3 | Public Goods Game | Provide a bonus to top-performing students | Encouraged motivation and effort in the program |
Stage 4 | Nash Equilibrium | Ensure high-quality training and job placements for students | Encouraged continued enrollment and future job opportunities |
I used the iterated prisoner's dilemma to incentivize households to enroll their children in the program. By providing free training to enrolled students, households were more likely to see the benefits of enrolling their children and were more willing to cooperate. This stage of the intervention had a positive outcome as it encouraged households to enroll their children in the program, which is necessary to provide adequate healthcare during the pandemic.
In the first stage, I used the iterated prisoner's dilemma to incentivize households to enroll their children in the program. By providing free training to enrolled students, households were more likely to see the benefits of enrolling their children and were more willing to cooperate. This stage of the intervention had a positive outcome as it encouraged households to enroll their children in the program, which is necessary to provide adequate healthcare during the pandemic.
In the second stage, I used the coordination game to encourage peer support and increase enrollment. By creating a social network of students in the program, I encouraged students to share information about the program and support each other. This stage of the intervention had a positive outcome as it led to increased enrollment numbers and a more supportive environment for students.
In the third stage, I used the public goods game to provide a bonus to top-performing students. By doing so, I encouraged motivation and effort in the program. This stage of the intervention had a positive outcome as it motivated students to work hard and perform well in the program.
In the fourth and final stage, I used Nash equilibrium to ensure that the program provided high-quality training and job placements for students. By doing so, I encouraged continued enrollment and future job opportunities. This stage of the intervention had a positive outcome as it ensured that students who completed the program received adequate job opportunities, which is necessary to sustain enrollment in the program.
Overall, the use of game theory applications in designing the healthcare intervention in rural Gujarat had a positive impact on all stakeholders involved. The households benefited from enrolling their children in the program, the students received high-quality training and job opportunities, and the community benefited from having more healthcare professionals to provide adequate care during the pandemic.
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