Payment matrix.

As healthcare systems grow in complexity, ensuring medical safety requires moving beyond traditional top-down regulation. While public participation is increasingly recognized as a vital component, a robust, generalizable framework to guide its implementation has been lacking. This study addresses this critical gap by proposing and rigorously validating a tripartite evolutionary game model that integrates the public, medical institutions, and government authorities. We test the model’s universality and effectiveness against empirical data from three diverse international case studies: tuberculosis (TB) treatment adherence in Saudi Arabia, COVID-19 vaccination compliance in China, and antibiotic prescription supervision in Vietnam. Our analysis reveals that higher health risks and public exposure rates act as powerful catalysts, significantly enhancing participation from both the public and institutions, thereby accelerating the system’s convergence to a stable, compliant state. We also find that medical institutions are highly sensitive to penalty intensity, adopting compliant practices only when a critical threshold is surpassed. These findings confirm the existence of a “virtuous cycle,” where engaged citizens and stringent oversight collaboratively improve medical compliance, a mechanism that holds true across varied healthcare contexts. This research provides not only a validated theoretical framework but also actionable insights for policymakers to design evidence-based, participatory regulatory strategies that can enhance the resilience and sustainability of global healthcare systems.随着医疗体系复杂度不断提升，保障医疗安全亟需突破传统自上而下的监管模式。尽管公众参与的重要性日益得到认可，但目前仍缺乏能够指导其落地实施的稳健且可推广的框架。本研究针对这一关键空白，提出并严格验证了一套整合公众、医疗机构与政府部门的三方演化博弈模型。本研究通过沙特阿拉伯结核病（TB）治疗依从性、中国新冠（COVID-19）疫苗接种依从性以及越南抗生素处方监管三个不同国际案例的实证数据，验证了该模型的普适性与有效性。分析结果显示，更高的健康风险与公众暴露率可作为强有力的催化因素，显著提升公众与医疗机构的参与积极性，进而加速系统收敛至稳定的合规状态。研究同时发现，医疗机构对处罚力度具有高度敏感性，仅当处罚强度突破临界阈值时，才会采取合规行为。上述研究结果证实了"良性循环"的存在：即积极参与的公众与严格的监管协同提升医疗合规性，这一机制在不同医疗场景中均成立。本研究不仅提供了经过验证的理论框架，还为政策制定者提供了可落地的决策参考，帮助其设计基于实证的公众参与式监管策略，进而提升全球医疗体系的韧性与可持续性。