Controversial Role of GPOs in Healthcare‐Product Supply Chains

This paper examines the controversial role that Group Purchasing Organizations (GPOs) play in the supply chains for healthcare products. Among the controversies, perhaps the most fundamental one is whether or not GPOs reduce purchasing costs for their members. However, the fiercest controversy is around the “contract administration fees (CAFs)” that GPOs charge to manufacturers. We examine these and other controversies using a Hotelling duopoly model. Among our conclusions: GPOs increase competition between manufacturers and lower prices for healthcare providers. However, GPOs reduce manufacturers' incentives to introduce innovations to existing products. We also demonstrate that the existence of lower off‐contract prices is not, per se, evidence of anticompetitive behavior on the part of GPOs. Indeed, we demonstrate that, under certain circumstances, the presence of a GPO lowers off‐contract prices. We also examine the consequences of eliminating the “safe harbor” provisions that permit healthcare GPOs to charge CAFs to manufacturers, and conclude that it would not affect any party's profits or costs.     

An Empirical Study of the Relations Between Hospital Volume,Teaching Status,and Service Quality

This paper contributes to research on quality drivers in healthcare settings by examining the relationships between patient volume, teaching mission, and process quality in US hospitals. To develop a model that accurately assesses the impact of patient volume and teaching status on quality, we draw on three related research streams pertaining to the volume–quality relationship, the comparative quality of care in teaching and non‐teaching hospitals, and quality drivers in service institutions. We propose the impact of patient volume on process quality varies across hospitals with different teaching intensities. The test of this proposition uses a large data set that measures process quality for treatments for heart attacks and heart failures in all major US hospitals. Our results suggest that, as hospital teaching intensity increases, greater patient volume is associated with decreased process quality. Never before was such a relationship uncovered. This initial finding has important practical implications. First, the regionalization policy of hospitals should be re‐evaluated in light of their teaching function. Second, the root causes for the lower quality scores of large, high resident‐to‐bed ratio teaching hospitals, compared with smaller versions, must be found.     

New Methods for Resolving Conflicting Requests with Examples from Medical Residency Scheduling

In scheduling medical residents, the objective is often to maximize resident satisfaction across the space of feasible schedules, relative to the many hard constraints that ensure appropriate patient coverage, adequate training opportunities, etc. A common metric of resident satisfaction is the number of time‐off requests that are granted. Simply maximizing this total, however, may lead to undesirable schedules since some requests have higher priority than others. For example, it might be better to grant one resident's request for a family member's wedding in place of two residents’ requests to attend a rugby game. Another approach is to assign a weight to each request and maximize the total weight of granted requests, but determining weights that accurately represent residents’ and schedulers’ preferences can be quite challenging. Instead, we propose to identify the exhaustive collection of maximally feasible and minimally infeasible sets of requests which can then be used by schedulers to select their preferred solution. Specifically, we have developed two algorithms, which we call Sequential Request Selection Via Cuts (Sequential RSVC) and Simultaneous Request Selection Via Cuts (Simultaneous RSVC), to identify these sets by solving two sequences of optimization problems. We present these algorithms along with computational results based on a real‐world problem of scheduling residents at the University of Michigan C.S. Mott Pediatric Emergency Department. Although we focus our exposition on the problem of resident scheduling, our approach is applicable to a broad class of problems with soft constraints.     

Are Patients Patient? The Role of Time to Appointment in Patient Flow

The current state of outpatient healthcare delivery is characterized by capacity shortages and long waits for appointments, yet a substantial fraction of valuable doctors’ capacity is wasted due to no‐shows. In this study, we examine the effect of wait to appointment on patient flow, specifically on a patient's decision to schedule an appointment and to subsequently arrive to it. These two decisions may be dependent, as appointments are more likely to be scheduled by patients who are more patient and are thereby more likely to show up. To estimate the effect of wait on these two decisions, we introduce the willingness to wait (WTW), an unobservable variable that affects both bookings and arrivals for appointments. Using data from a large healthcare system, we estimate WTW with a state‐of‐the‐art non‐parametric method. The WTW, in turn, allows us to estimate the effect of wait on no‐shows. We observe that the effect of increased wait on the likelihood of no‐shows is disproportionately greater among patients with low WTW. Thus, although reducing the wait to an appointment will enable a provider to capture more patient bookings, the effects of wait time on capacity utilization can be non‐monotone. Our counterfactual analysis suggests that increasing wait times can sometimes be beneficial for reducing no‐shows.     

基于病患就诊行为的医院预约挂号系统评价研究

目的:在对患者就诊习惯前期调查的基础上,对常州市某三甲医院预约挂号系统的实现进行说明和评价,并对预约服务在系统整合中的提升空间做出分析,从而实现更好地为病患服务的目的?方法:采用随机抽样对江苏省常州市某三甲医院2 510例门诊患者开展预约挂号服务质量的问卷调查?结果:通过对门诊患者预约?就诊情况的分析,预约挂号系统在一定程度上解决了挂号难的问题,在实现患者挂号?退号?换号?预约挂号等需求上取得了一定效果,但仍存在患者未能有效分流,同时号源存在浪费现象等实际问题?结论:应加强预约挂号系统各页面的宣传力度以及开发提醒功能,并在服务站?预约网站配备相关专业人员进行答疑解惑,同时设置爽约黑名单系统以及门诊医生(专家)提示系统,尝试开展个性化预约服务?     

Perceived violence climate: A new construct and its relationship to workplace physical violence and verbal aggression, and their potential consequences

Workplace accidents and violence are both potential sources of employee injuries that have been dealt with in entirely separate literatures. In this study we adapted the concept of safety climate from the accident/injury literature to violence in developing the concept of perceived violence climate. A scale was developed to assess perceived violence climate, including items about management attention, concern, and policies designed to keep employees safe from violence. Data were collected from a sample of 198 nurses from a US Hospital. Perceived violence climate was found to correlate significantly with both physical violence and verbal aggression experienced by the nurses, injury from violence, and perceptions of workplace danger. Furthermore, regression analyses showed that climate explained additional variance in psychological strain and perceptions of danger over experienced violence. These results have implications for interventions aimed at producing a good perceived violence climate in order to reduce the incidence of violence and aggression within an organization.     

全民医保目标下经办管理现状审视与发展对策

新医改方案的出台,使得医保经办管理能力建设地位凸显。依据全民医保目标对于经办管理的工作要求,在归纳总结＂两大服务功能倒推分析＂＂指标设立与数据论证分析＂等方法探究医保经办管理水平影响因素的基础上,系统审视医保经办管理现状,并就经办机构内部管理、信息化建设、社会协作等方面存在的问题展开剖析,进而有针对性地提出树立医保经办治理理念、加强法规建设、创新经办管理模式等建议,以推进全民医保目标实现。     

葛洪养生思想管窥

葛洪是中国古代知名的养生学家、道学家和思想家，在中国道教史和哲学史上都占有非常重要的地位。他在长期实践的基础上博采众长，提出了自己的养生内炼思想，形成了一个全面的“内修外养”的养生内炼体系。     

The social constructions of drug users in professional interventions

This qualitative study analyses the construction of a subject who uses drugs (injected drugs) so as to offer psychosocial proposals for social healthcare interventions within this collective, and thereby contribute to social healthcare policies that optimise treatment for drug use. The results indicate that identity is connected to positions that are activated in interactions and relationships between users and professionals in various day-to-day contexts of healthcare and treatment. We have labelled these activated positions: therapeutic, drug-sensory, consumerist, legal-repressive and group-community. Understanding them provides clues that may improve interventions in health and legal contexts. These clues include understanding the tensions between the subject and the substance, considering the stigmatised image and identity, and supporting the idea of the existence of dilemmas in users and professionals, as this may allow transformations to occur in the mutual relationships that are established.     

Bivariate zero-inflated negative binomial regression model with applications

Count data often display excessive number of zero outcomes than are expected in the Poisson regression model. The zero-inflated Poisson regression model has been suggested to handle zero-inflated data, whereas the zero-inflated negative binomial (ZINB) regression model has been fitted for zero-inflated data with additional overdispersion. For bivariate and zero-inflated cases, several regression models such as the bivariate zero-inflated Poisson (BZIP) and bivariate zero-inflated negative binomial (BZINB) have been considered. This paper introduces several forms of nested BZINB regression model which can be fitted to bivariate and zero-inflated count data. The mean–variance approach is used for comparing the BZIP and our forms of BZINB regression model in this study. A similar approach was also used by past researchers for defining several negative binomial and zero-inflated negative binomial regression models based on the appearance of linear and quadratic terms of the variance function. The nested BZINB regression models proposed in this study have several advantages; the likelihood ratio tests can be performed for choosing the best model, the models have flexible forms of marginal mean–variance relationship, the models can be fitted to bivariate zero-inflated count data with positive or negative correlations, and the models allow additional overdispersion of the two dependent variables.