Sequencing and Scheduling Appointments with Potential Call‐In Patients

This paper studies appointment scheduling for a combination of routine patients who book well in advance and last‐minute patients who call for an appointment later that same day. We determine when these same‐day patients should be scheduled throughout the day, and how the prospect of their arrivals affects the appointment times of the routine patients. By formulating the problem as a stochastic linear program, we are able to incorporate random and heterogeneous service times and no‐show rates, ancillary physician tasks, and appointment delay costs for same‐day patients who prefer to see the doctor as early as possible. We find that the optimal patient sequence is quite sensitive to the no‐show probabilities and the expected number of same‐day patients. We also develop two simple heuristic solutions to this combinatorial sequencing problem.     

Linking Process Quality and Resource Usage: An Empirical Analysis

Motivated by an increasing adoption of evidence‐based medical guidelines in the delivery of medical care, we examine whether increased adherence to such guidelines (typically referred to as higher process quality) is associated with reduced resource usage in the course of patient treatment. In this study, we develop a sample of US hospitals and use cardiac care as our context to empirically examine our questions. To measure a patient's resource usage, we use the total length of stay, which includes any additional inpatient stay necessitated by unplanned readmissions within thirty days after initial hospitalization. We find evidence that higher process quality, and more specifically its clinical (as opposed to its administrative) dimensions, are associated with a reduction in resource usage. Moreover, the standardization of care that is achieved via the implementation of medical guidelines, makes this effect more pronounced in less focused environments: higher process quality is more beneficial when the cardiac department's patient population is distributed across a wider range of medical conditions. We explore the implications of these findings for process‐oriented pay‐for‐performance programs, which tie the reimbursement of hospitals to their adherence to evidence‐based medical guidelines.     

试论德国的医疗保险体制改革

德国是世界上最早实施社会医疗保障的国家。德国的医疗保险体系以社会医疗保险为主,商业医疗保险为辅。德国的医疗保险体系具有优质、高效、公平、覆盖面广等优点,但近年来也难以摆脱资源浪费,经费入不敷出等问题的困扰。德国于20世纪90年代和21世纪初持续进行医疗保险体制改革,采取了取消部分医疗补贴,提高某些医疗服务的自费比例,扩大有偿医疗服务范围,并组建了由政府机构,保险公司和医保医院共同构成的独立机构,对疾病认证,治疗程序和医疗服务质量进行统一规定和管理。本文对德国医疗保险体制改革进行了系统介绍和评估,对构建和完善具有中国特色的医疗保险体制具有参考借鉴价值。     

加拿大的卫生政策及其对中国卫生改革的借鉴

卫生政策在改善与增进人口健康中发挥了重要作用。文章通过对加拿大卫生系统相关立法进程的系统回顾与分析。发现加拿大医疗系统的特点是公共筹资而非私人运作,而全覆盖、可携带性、综合性、可及性以及公共管理等五项基础性原则保证了加拿大卫生系统的成功运行。文章着重回答了有哪些政策可以借鉴,如何借鉴。以及哪些政策的不良后果可以避免等。     

Operationalising lean in healthcare: the impact of professionalism

Abstract

Lean is endorsed as policy in practice in the UK but the challenges and complexities affecting Lean in healthcare are still to be adequately assessed. Through a qualitative single case study of an NHS organisation implementing Lean, 43 interviews with multi-disciplinary team members involved in Lean were conducted. The progress of Lean is found to be inhibited as medical professionals have failed to engage or provide clinical leadership in supporting the trajectory of Lean. This resulted in limited outcomes, sustainability implications, and failed projects. Lean is challenged by complexity and this is evident in conflicts between professional identity, corresponding status and clinical/managerial relationships. Medical professionals as a group have received a limited focus in papers assessing the progress of Lean in Healthcare from an operational perspective. Going forward, strategies for mitigating the negative impact of this can be developed to support operational managers in the healthcare domain.     

On the Integration of Science and Practice in College Health

Abstract

College health professionals want to assure the unique healthcare and health education needs of college students will continue to be met under national and state healthcare reform. This may be an “all or nothing” proposition. Either colleges and universities will have exclusive control of healthcare delivery for the college student population or else college health will not be a major force in healthcare reform. If college health is to play a meaningful role in future government-controlled health insurance programs, it must first demonstrate that current health services and insurance financing programs meet minimum quality standards. This proposal calls for expanding existing federal laws to create qualified student health plans and integrating the college health model into a reform package based on employer-sponsored health insurance. The concept of qualified student health plans allows for a high degree of flexibility that can be integrated into the majority of state and federal healthcare reform proposals, including the plan proposed by President Clinton, that are not based on a single-payer system. Ultimately, the authors suggest, their proposed plan would eliminate the current situation, in which large numbers of college students are uninsured or underinsured.     

A Qualitative Exploratory Study on the Service Delivery System for the New Long-Term Care Insurance System in Korea

ABSTRACT

To cope with the rapid growth in its aging population, the Korean government introduced a new social long-term care insurance (LTCI) system for elderly people beginning in July 2008. This study aims to understand how National Health Insurance Corporation (NHIC) staff and home-visiting service providers experienced and evaluated the new service delivery system. A total of 26 semistructured in-depth interviews were conducted with NHIC staff primarily responsible for the functional assessment of the elderly and the home-visiting service providers responsible for providing direct services to elderly clients. In summary, interviewees had negative experiences with the new service delivery system such as difficulties in carrying out their roles. The findings suggest that Korea's new LTCI service delivery system faces challenges and that a more active role for the Korean government, especially regarding the introduction of a proper care management system, is needed to address the issues. Future research with larger sample sizes is needed to examine and understand the issues in detail.     

The healthcare supply network: current state of the literature and research opportunities

Abstract

This literature review maps recent studies addressing supply chain management (SCM) in the healthcare sector through a systematic approach that synthesises 74 empirical studies (2006–2016). Our approach adopts a network lens to map the literature and offers key contributions to the field. First, we show that there is a lack of network level studies. Second, there is an imbalance of research attention regarding the various types of supply, namely health services, medicines, medical supplies and blood supply. Third, we underline the advantages of the network lens, indicating network actors and flows between those actors that need further research. Fourth, we show an alarming lack of theoretical lens in healthcare SCM studies and draw attention to the fact that even when explicitly adopting a theory, some studies show inconsistencies between theoretical lens and level of analysis. Ultimately, we offer a map of future research for healthcare SCM through a network lens in order to improve the understanding the complexities of the healthcare sector.     

The effect of capacity management strategies on employees' well-being: A quantitative investigation into the long-term healthcare industry

The aim of this study is to understand the effects of different capacity management strategies on the well-being of employees in long-term healthcare organizations. Such strategies may produce psychological effects in terms of job satisfaction and well-being among employees, namely frontline employees, thus affecting service quality. We collected 2158 observations from 42 nursing homes in Italy. Our results show that all capacity management strategies addressed in this study can influence the perceived degree of fatigue or of job hazard, and some of them can influence both. Moreover, a better perception of job hazard and fatigue leads to a higher degree of reported well-being from employees, although with the former, it is only through the mediation of job satisfaction. We conclude our paper by discussing theoretical contributions and policy implications.     

Amplifying accountability by benchmarking results at district and national levels

This multi‐level ethnography of the Zambian health system illustrates the importance of top‐down accountability, and how it has emerged in a historically neglected sector. Maternal healthcare indicators are prioritized when they are benchmarked, at district and national levels. The realization that Zambia was lagging behind African countries in making progress towards Millennium Development Goal (MDG) 5 (to reduce the maternal mortality ratio by three quarters) appears to have evoked reputational concerns and revealed inspirational possibilities. Growing prioritization also stems from a change in incentives, with some partner funding being conditional on the proportion of deliveries attended by skilled health personnel.