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Blockchain-based healthcare IoT technology research enhances security for smart healthcare services such as real-time monitoring and remote disease diagnosis. To incentivize positive behavior among participants within a blockchain-based smart healthcare system, existing efforts employ benefit distribution and reputation assessment methods to enhance performance. Yet, there remains a significant gap in multidimensional assessment strategies and consensus improvements in addressing complex healthcare scenarios. In this paper, we propose a blockchain and trusted reputation assessment-based incentive mechanism for healthcare services (BtRaI). BtRaI provides a realistic and comprehensive reputation assessment with feedback to motivate blockchain consensus node participation, thus effectively defending against malicious behavior in the healthcare service system. Specifically, BtRaI first introduces multiple moderation factors for comprehensive multidimensional reputation assessment and credibly records the assessment results on the blockchain. Then, we propose an improved PBFT algorithm, grounded in the reputation assessment, to augment blockchain consensus efficiency. Finally, BtRaI designs a token-based reward and punishment mechanism to motivate honest participation in the blockchain, inhibit potential misbehavior, and promote enhanced service quality in the healthcare system. Theoretical analysis and simulation experiments conducted across various scenarios demonstrate that BtRaI effectively suppresses malicious attacks in healthcare services , improves blockchain node fault tolerance rates, and achieves blockchain transaction processing efficiency within 0.5 s in a 100-node consortium chain. BtRaI’s reputation assessment and token incentive mechanism, characterized by realistic differentiation granularity and change curves, are well-suited for dynamic and complex healthcare service environments. • A credible and practical scheme (BtRaI) is used to enhance the quality and efficiency of healthcare services. • We propose a comprehensive and credible reputation assessment method to suppress malicious scoring attacks. • We propose a consensus mechanism with high fault tolerance and efficiency. • Reputation-based token rewards and penalties are designed to encourage improvements in service quality. • Our scheme (BtRaI) can be effectively applied to healthcare service incentives in dynamic and complex scenarios.
Liu et al. (Sat,) studied this question.