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Journal Article•DOI•

Medical Care Research and Review. Foreword.

Jon B. Christianson
01 Dec 2009-Medical Care Research and Review (SAGE Publications Inc.)-Vol. 66, Iss: 6
About: This article is published in Medical Care Research and Review.The article was published on 2009-12-01. It has received 5 citations till now.
Citations
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Journal Article•DOI•
Gatekeepers at Work: An Empirical Analysis of a Maternity Unit

[...]

Michael Freeman1, Nicos Savva2, Stefan Scholtes1•
University of Cambridge1, London Business School2
01 Oct 2017-Management Science
TL;DR: This work uses a detailed operational and clinical data set from a maternity hospital to investigate how workload affects decisions in gatekeeper-provider systems, where the servers act as gatekeepers to specialists but may also attempt to serve customers themselves, albeit with a probability of success decreasing in the complexity of the customers’ needs.
Abstract: We use a detailed operational and clinical data set from a maternity hospital to investigate how workload affects decisions in gatekeeper-provider systems, where the servers act as gatekeepers to specialists but may also attempt to serve customers themselves, albeit with a probability of success that is decreasing in the complexity of the customers’ needs. We study the effect of workload during a service episode on gatekeepers’ service configuration decisions and the rate at which gatekeepers refer customers to a specialist. We find that gatekeeper-providers (midwives in our context) make substantial use of two levers to manage their workload (measured as patients per midwife): they ration resource-intensive discretionary services (epidural analgesia) for customers with noncomplex service needs (mothers with spontaneous onset of labor) and, at the same time, increase the rate of specialist referral (physician-led delivery) for customers with complex needs (mothers with pharmacologically induced labor). Th...

133 citations

Cites background from "Medical Care Research and Review. F..."

  • ...Hopp et al. (2007) present a model that shows that the service configuration decision may be affected by workload, i....

    [...]

  • ...Hasija et al. (2005) extend these results to a stochastic system, while Lee et al....

    [...]

  • ...More specifically, as in Green et al. (2013), we show that increasing staffing levels may generate a cost saving that (partially) offsets the cost of extra staff (in their case, higher staffing is associated with reduced absenteeism, while in our case, with a reduction in referrals for complex…...

    [...]

  • ...(2012) find a reduction in hospital revenue per patient as discharging physician workload increases, and Green et al. (2013) show that nurse absenteeism rates are linked to anticipated workload.(1) Aside from healthcare, Tan and Netessine (2014) find a non-linear effect between the number of diners assigned to waiting staff and staff sales performance in the context of a restaurant chain: Sales initially increase with load as staff become more motivated but ultimately decline as staff place more emphasis on speed. With the last two papers we share an emphasis on the implications of the endogenous response to workload on staffing decisions. More specifically, as in Green et al. (2013), we show that increasing staffing levels may generate a cost saving that (partially) offsets the cost of extra staff (in their case, higher staffing is associated with reduced absenteeism, while in our case, with a reduction in referrals for complex cases). However, as in Tan and Netessine (2014), higher staffing may also compromise aspects of system performance (in their case, this is associated with lower motivation to cross-sell and up-sell, while in our case, with an increase in discretionary interventions for non-complex cases). Our study deviates from previous work as (i) we focus on the impact of workload on a two-tier GP system, (ii) we examine two distinct buffers, referral and service configuration, which a GP can use to absorb workload variability, and (iii) we examine how characteristics of the customers’ service needs, and complexity in particular, interact with workload. Finally, our work is also related to Kim et al. (2014) and KC and Terwiesch (2012), who study decisions to admit emergency department (ED) patients to the intensive-care unit (ICU)....

    [...]

  • ...Powell et al. (2012) find a reduction in hospital revenue per patient as discharging physician workload increases, and Green et al. (2013) show that nurse absenteeism rates are linked to anticipated workload.1 Aside from healthcare, Tan and Netessine (2014) find a non-linear effect between the…...

    [...]

Journal Article•DOI•
Context-based strategies for engaging consumers with public reports about health care providers.

[...]

Dale Shaller, David E. Kanouse1, Mark Schlesinger2•
RAND Corporation1, Yale University2
01 Oct 2014-Medical Care Research and Review
TL;DR: This work identifies three key factors influencing consumer engagement and shows how they manifest in different ways and combinations for four particular choice contexts that appear to offer realistic opportunities for engagement.
Abstract: Efforts to engage consumers in the use of public reports on health care provider performance have met with limited success. Fostering greater engagement will require new approaches that provide consumers with relevant content at the time and in the context they need to make a decision of consequence. To this end, we identify three key factors influencing consumer engagement and show how they manifest in different ways and combinations for four particular choice contexts that appear to offer realistic opportunities for engagement. We analyze how these engagement factors play out differently in each choice context and suggest specific strategies that sponsors of public reports can use in each context. Cross-cutting lessons for report sponsors and policy makers include new media strategies such as a commitment to adaptive web-based reporting, new metrics with richer emotional content, and the use of navigators or advocates to assist consumers with interpreting reports.

23 citations

Pay-for-performance for healthcare providers: Design, performance measurement, and (unintended) effects

[...]

Frank Eijkenaar
14 Nov 2013
TL;DR: This thesis aims to provide insight in key conceptual and practical issues in the design and implementation of P4P for healthcare providers, and to address important empirical questions about performance measurement.
Abstract: textHealthcare systems around the world are characterized by a suboptimal delivery of healthcare services. There has been a growing belief among policymakers that many deficiencies (e.g., in the quality of care) stem from flawed provider payment systems creating perverse incentives for healthcare providers. In several countries this has led to reforms based on pay-for-performance (P4P), a payment approach in which healthcare providers receive explicit financial incentives to improve the quality and efficiency of care. Over the past decade, P4P has attracted widespread interest, with programs being uncritically implemented in many countries. In contrast to what this interest suggests, however, to date P4P does not appear to have been very effective in delivering the desired improvements. Moreover, several unintended effects have been demonstrated. In part, these disappointing results may well have been due to the limited knowledge about crucial aspects of the design and implementation of P4P. By identifying and analyzing these aspects, synthesizing empirical literature on (unintended) effects of P4P, and addressing important empirical questions about performance measurement, this thesis aims to provide insight in key conceptual and practical issues in the design and implementation of P4P for healthcare providers.

18 citations

Cites background from "Medical Care Research and Review. F..."

  • ...Moreover, even if information on outcome quality can be routinely collected and risk adjustment would be adequate, these measures will often not be useful for P4P purposes because of low reliability as a result of small sample size (Krein et al., 2002; Nyweide et al., 2009)....

    [...]

  • ..., the proportion of total variation that can be attributed to between-provider variation) are large (Nyweide et al., 2009; Scholle et al., 2008; Adams et al., 2010a)....

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  • ...Patient panels of individual physicians are typically too small to measure individual performance reliably (Hofer et al., 1999; Krein et al., 2002; Nyweide et al., 2009)....

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  • ...Consequently, targeting individuals will often result in misclassification of providers and incorrect allocation of payments (Adams et al., 2010a; Nyweide et al., 2009)....

    [...]

  • ..., 2010b), possibly resulting in misclassification of providers and incorrect allocation of incentive payments (Nyweide et al., 2009; Adams et al., 2010a)....

    [...]

Journal Article•DOI•
The reform of the medical welfare system and health equity for the elderly in China: a study in Zhejiang

[...]

Xiaoting Liu1, Hung Wong2•
Zhejiang University1, The Chinese University of Hong Kong2
10 May 2016-The Journal of Chinese Sociology
TL;DR: This study advocates the perspective of health equity for vulnerable groups, a transition from emphasizing opportunity equity to stressing outcome equity, and the construction of universal health insurance and long-term care system for the disabled elderly.
Abstract: Health equity is the basic theory of universal health insurance and the objective of reform of the medical welfare system. Based on health equity theory with the perspective of giving priority to disadvantaged groups, this article takes Zhejiang province as an example and adopts a mixed-method approach to explore the effects of the reform of the medical welfare system on health equity for older people. The structural equation model (SEM)-based nonrecursive path analysis demonstrates an improvement of health equity for insured elders of the Basic Medical Insurance for Employees (BMIE) and the Urban Basic Medical Insurance for Residents (UBMIR) as a result of an increased utilization of healthcare. However, there is little difference in terms of the utilization of healthcare and health outcomes between old people insured by the New Rural Cooperative Medical System (NRCMS) and those without medical insurance. This results from the low-level benefits of the insurance policy and defective policy design. A qualitative analysis further discovers the insufficient protection of health equity for several types of vulnerable aged groups in the process of healthcare delivery. Finally, this study advocates the perspective of health equity for vulnerable groups, a transition from emphasizing opportunity equity to stressing outcome equity, and the construction of universal health insurance and long-term care system for the disabled elderly.

11 citations

Journal Article•DOI•
HIV: The invisible epidemic of the United States healthcare system

[...]

Robert J. Smith1, B. D. Aggarwala2•
University of Ottawa1, University of Calgary2
07 Jan 2010-Social Theory and Health
TL;DR: It is argued that the HIV epidemic in the United States is considerably more widespread than is officially reported and theUnited States healthcare system provides an additional pressure that simultaneously discriminates against and ignores the very people it should be targeting most.
Abstract: We argue that the HIV epidemic in the United States is considerably more widespread than is officially reported. The occasional reports of outbreaks in cities like Washington DC, comparison with other countries in the developed world and our mathematical models, all point to the conclusion that the number of people living with HIV, but not AIDS, in the United States is more than four times larger than the current estimate. Although there are many reasons that HIV-positive individuals may not be aware of their serostatus, we argue that the United States healthcare system provides an additional pressure that simultaneously discriminates against and ignores the very people it should be targeting most.

7 citations

References
More filters
Journal Article•DOI•
Gatekeepers at Work: An Empirical Analysis of a Maternity Unit

[...]

Michael Freeman1, Nicos Savva2, Stefan Scholtes1•
University of Cambridge1, London Business School2
01 Oct 2017-Management Science
TL;DR: This work uses a detailed operational and clinical data set from a maternity hospital to investigate how workload affects decisions in gatekeeper-provider systems, where the servers act as gatekeepers to specialists but may also attempt to serve customers themselves, albeit with a probability of success decreasing in the complexity of the customers’ needs.
Abstract: We use a detailed operational and clinical data set from a maternity hospital to investigate how workload affects decisions in gatekeeper-provider systems, where the servers act as gatekeepers to specialists but may also attempt to serve customers themselves, albeit with a probability of success that is decreasing in the complexity of the customers’ needs. We study the effect of workload during a service episode on gatekeepers’ service configuration decisions and the rate at which gatekeepers refer customers to a specialist. We find that gatekeeper-providers (midwives in our context) make substantial use of two levers to manage their workload (measured as patients per midwife): they ration resource-intensive discretionary services (epidural analgesia) for customers with noncomplex service needs (mothers with spontaneous onset of labor) and, at the same time, increase the rate of specialist referral (physician-led delivery) for customers with complex needs (mothers with pharmacologically induced labor). Th...

133 citations

Journal Article•DOI•
Context-based strategies for engaging consumers with public reports about health care providers.

[...]

Dale Shaller, David E. Kanouse1, Mark Schlesinger2•
RAND Corporation1, Yale University2
01 Oct 2014-Medical Care Research and Review
TL;DR: This work identifies three key factors influencing consumer engagement and shows how they manifest in different ways and combinations for four particular choice contexts that appear to offer realistic opportunities for engagement.
Abstract: Efforts to engage consumers in the use of public reports on health care provider performance have met with limited success. Fostering greater engagement will require new approaches that provide consumers with relevant content at the time and in the context they need to make a decision of consequence. To this end, we identify three key factors influencing consumer engagement and show how they manifest in different ways and combinations for four particular choice contexts that appear to offer realistic opportunities for engagement. We analyze how these engagement factors play out differently in each choice context and suggest specific strategies that sponsors of public reports can use in each context. Cross-cutting lessons for report sponsors and policy makers include new media strategies such as a commitment to adaptive web-based reporting, new metrics with richer emotional content, and the use of navigators or advocates to assist consumers with interpreting reports.

23 citations

Pay-for-performance for healthcare providers: Design, performance measurement, and (unintended) effects

[...]

Frank Eijkenaar
14 Nov 2013
TL;DR: This thesis aims to provide insight in key conceptual and practical issues in the design and implementation of P4P for healthcare providers, and to address important empirical questions about performance measurement.
Abstract: textHealthcare systems around the world are characterized by a suboptimal delivery of healthcare services. There has been a growing belief among policymakers that many deficiencies (e.g., in the quality of care) stem from flawed provider payment systems creating perverse incentives for healthcare providers. In several countries this has led to reforms based on pay-for-performance (P4P), a payment approach in which healthcare providers receive explicit financial incentives to improve the quality and efficiency of care. Over the past decade, P4P has attracted widespread interest, with programs being uncritically implemented in many countries. In contrast to what this interest suggests, however, to date P4P does not appear to have been very effective in delivering the desired improvements. Moreover, several unintended effects have been demonstrated. In part, these disappointing results may well have been due to the limited knowledge about crucial aspects of the design and implementation of P4P. By identifying and analyzing these aspects, synthesizing empirical literature on (unintended) effects of P4P, and addressing important empirical questions about performance measurement, this thesis aims to provide insight in key conceptual and practical issues in the design and implementation of P4P for healthcare providers.

18 citations

Journal Article•DOI•
The reform of the medical welfare system and health equity for the elderly in China: a study in Zhejiang

[...]

Xiaoting Liu1, Hung Wong2•
Zhejiang University1, The Chinese University of Hong Kong2
10 May 2016-The Journal of Chinese Sociology
TL;DR: This study advocates the perspective of health equity for vulnerable groups, a transition from emphasizing opportunity equity to stressing outcome equity, and the construction of universal health insurance and long-term care system for the disabled elderly.
Abstract: Health equity is the basic theory of universal health insurance and the objective of reform of the medical welfare system. Based on health equity theory with the perspective of giving priority to disadvantaged groups, this article takes Zhejiang province as an example and adopts a mixed-method approach to explore the effects of the reform of the medical welfare system on health equity for older people. The structural equation model (SEM)-based nonrecursive path analysis demonstrates an improvement of health equity for insured elders of the Basic Medical Insurance for Employees (BMIE) and the Urban Basic Medical Insurance for Residents (UBMIR) as a result of an increased utilization of healthcare. However, there is little difference in terms of the utilization of healthcare and health outcomes between old people insured by the New Rural Cooperative Medical System (NRCMS) and those without medical insurance. This results from the low-level benefits of the insurance policy and defective policy design. A qualitative analysis further discovers the insufficient protection of health equity for several types of vulnerable aged groups in the process of healthcare delivery. Finally, this study advocates the perspective of health equity for vulnerable groups, a transition from emphasizing opportunity equity to stressing outcome equity, and the construction of universal health insurance and long-term care system for the disabled elderly.

11 citations

Journal Article•DOI•
HIV: The invisible epidemic of the United States healthcare system

[...]

Robert J. Smith1, B. D. Aggarwala2•
University of Ottawa1, University of Calgary2
07 Jan 2010-Social Theory and Health
TL;DR: It is argued that the HIV epidemic in the United States is considerably more widespread than is officially reported and theUnited States healthcare system provides an additional pressure that simultaneously discriminates against and ignores the very people it should be targeting most.
Abstract: We argue that the HIV epidemic in the United States is considerably more widespread than is officially reported. The occasional reports of outbreaks in cities like Washington DC, comparison with other countries in the developed world and our mathematical models, all point to the conclusion that the number of people living with HIV, but not AIDS, in the United States is more than four times larger than the current estimate. Although there are many reasons that HIV-positive individuals may not be aware of their serostatus, we argue that the United States healthcare system provides an additional pressure that simultaneously discriminates against and ignores the very people it should be targeting most.

7 citations