A Stochastic Queueing Model for Capacity Allocation in the Hierarchical Healthcare Delivery System

2019 ◽  
Vol 36 (01) ◽  
pp. 1950005
Author(s):  
Jianpei Wen ◽  
Hanyu Jiang ◽  
Jie Song
Keyword(s):  
Delivery System ◽  
Optimal Allocation ◽  
Healthcare Delivery ◽  
Capacity Allocation ◽  
Patient Choice ◽  
Management Tool ◽  
Point Problem ◽  
Referral Process ◽  
Healthcare Delivery System ◽  
The Impact

We use the capacity allocation as a demand management tool to optimize the patient flow distribution on a hierarchical healthcare delivery system, which is a mixture of patient choice and gatekeeping. Capacity allocation for such service system can be challenging because of the inherent stochastic referral process and patients’ heterogeneous delay sensitivities. In this research, a stochastic queueing-based model is proposed to find the optimal allocation of the limited service capacity of the second level of experts. Considering the impact of the deficiency of the skill level and the amount of gatekeepers, the stochastic referral process is modeled with a tandem queue. By solving a fixed-point problem, we show that there is an unique optimal allocation and corresponding equilibrium demand. We carry out numerical studies and find that providing two alternatives for patients can be better than gatekeeper system, when the capacity of the gatekeeper is moderate compared to patients’ potential demand. Results also indicate that the optimal allocation is robust in terms of the referral rate and the mistreatment rate when two rates are less than corresponding thresholds.

Healthcare of Vulnerable Populations: Through the Lens of Halldorsdottir’s Theory

2010 ◽  
Vol 14 (3) ◽  
pp. 53-59 ◽  
Author(s):  
Denise Nagle Bailey
Keyword(s):  
Delivery System ◽  
Vulnerable Populations ◽  
Healthcare Access ◽  
Healthcare Delivery ◽  
Poor Health ◽  
System Implementation ◽  
Healthcare Delivery System ◽  
Patient’S Perspective ◽  
Healthcare Coverage ◽  
The Impact

This paper explores caring within the context of healthcare access in vulnerable populations. Specifically, it connects how underserved status heightens an individual’s vulnerability to poor health. With the increase of disparities and inequalities that exist in the healthcare delivery system, implementation of caring and caring theory are examined as a plausible means to ameliorate the impact of inadequate healthcare coverage. Halldorsdottir’s (1996) theory of caring and uncaring encounters, within nursing and healthcare, from the patient’s perspective frames the discussion.

Health Information Technology

2019 ◽  
Author(s):  
Jordan Everson ◽  
Melinda Beeuwkes Buntin
Keyword(s):  
Information Technology ◽  
Health Information Technology ◽  
Health Information ◽  
Delivery System ◽  
Healthcare Delivery ◽  
Healthcare Organizations ◽  
Healthcare Delivery System ◽  
Learning Health System ◽  
Adoption And Diffusion ◽  
The Impact

The potential for health information technology (HIT) to reshape the information-intensive healthcare industry has been recognized for decades. Nevertheless, the adoption and use of IT in healthcare has lagged behind other industries, motivating governments to take a role in supporting its use to achieve envisioned benefits. This dynamic has led to three major strands of research. Firstly, the relatively slow and uneven adoption of HIT, coupled with government programs intended to speed adoption, has raised the issue of who is adopting HIT, and the impact of public programs on rates of adoption and diffusion. Secondly, the realization of benefits from HIT appears to be occurring more slowly than its proponents had hoped, leading to an ongoing need to empirically measure the effect of its use on the quality and efficiency of healthcare as well as the contexts under which benefits are best realized. Thirdly, increases in the adoption and use of HIT have led to the potential for interoperable exchange of patient information and the dynamic use of that information to drive improvements in the healthcare delivery system; however, these applications require developing new approaches to overcoming barriers to collaboration between healthcare organizations and the HIT industry itself. Intertwined through each of these issues is the interaction between HIT as a tool for standardization and systemic change in the practice of healthcare, and healthcare professionals’ desire to preserve autonomy within the increasingly structured healthcare delivery system. Innovative approaches to improve the interactions between professionals, technology, and market forces are therefore necessary to capitalize on the promise of HIT and develop a continually learning health system.

scholarly journals Patient Choice and Willingness Toward Gatekeepers as First-Contact Medical Institutions in Chinese Tiered Healthcare Delivery System: A Cross-Sectional Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Xia Li ◽  
Liang Zhang ◽  
Zhong Li ◽  
Wenxi Tang
Keyword(s):  
Delivery System ◽  
Family Income ◽  
Healthcare Delivery ◽  
Binary Logistic Regression ◽  
Cross Sectional Study ◽  
Patient Choice ◽  
Healthcare Delivery System ◽  
Cross Sectional ◽  
Primary Care Institutions ◽  
First Contact

Introduction: Gatekeeping mechanism of primary care institutions (PCIs) is essential in promoting tiered healthcare delivery system in China. However, patients seeking for higher-level institutions instead of gatekeepers as their first contact has persisted in the past decade. This study aims to explain patients' choice and willingness and to provide potential solutions.Methods: A survey was conducted among residents who had received medical care within the previous 14 days. Patients' choice and willingness of PCIs for first contact together with influencing factors were analyzed using binary logistic regression.Results: Of 728 sampled patients in Hubei, 55.22% chose PCIs for first contact. Patients who are older, less educated, with lower family income, not living near non-PCIs, with better self-perceived health status, only buying medicines, and living in rural instead of urban area had significantly higher probability of choosing PCIs. As of willingness, over 90% of the patients inclined to have the same choice for their first contact under similar health conditions. Service capability was the primary reason limiting patients' choice of PCIs.Conclusions: The gatekeeper system did not achieve its goal which was 70% of PCIs among all kinds of institutions for first contact. Future measures should aim to improve gate-keepers' capability.

The Impact of Secondary Environmental Variables on OECD Healthcare Efficiency: A Robust Conditional Approach

2019 ◽  
Vol 19 (2) ◽  
Author(s):  
Richard Gearhart
Keyword(s):  
Health Insurance ◽  
Healthcare System ◽  
Delivery System ◽  
Environmental Variables ◽  
Social Protection ◽  
Healthcare Delivery ◽  
Substantial Part ◽  
Healthcare Delivery System ◽  
Healthcare Efficiency ◽  
The Impact

AbstractIn this paper, I estimate country-level efficiency using a newer order-mestimator where I condition efficiency estimates on secondary environmental variables. This allows me to identify which variables influence the effectiveness of a healthcare delivery system. I find that not controlling for secondary environmental variables leads to the average OECD country being 11% inefficient; after controlling for demographics and economic (social protection) environmental variables, inefficiency reduces to 7% (5%). This provides evidence that a substantial part of the inefficiencies of a healthcare system is related to demographics, socioeconomics, and the structure of the healthcare delivery system. Using the second-stage results, I find lower healthcare spending, both as a percent of GDP and total out-of-pocket, as well as more of the population covered by public health insurance, is related to better efficiency. Lower fertility rates, lower immigration rates, higher incomes, and lower pharmaceutical doses are also consistent with better healthcare efficiency. Lastly, a healthcare system that provides a basic benefits package but allows for purchase of private health insurance, with moderate gatekeeping and flexibility to increase the budget for healthcare through public and private financing, are the most efficient healthcare systems.

The healthcare delivery system: an overview

2017 ◽  
Author(s):  
Jan Abel Olsen
Keyword(s):  
Delivery System ◽  
Chronic Care ◽  
Tertiary Care ◽  
Healthcare Delivery ◽  
Healthcare Delivery System ◽  
Care Level ◽  
Primary Care Level ◽  
Internal Markets ◽  
System A ◽  
Policy Challenge

This chapter provides an overview of the healthcare delivery system. A figure illustrates how six different parts of the system relate to each other. The primary care level plays a key role in many countries by representing the gate, in which referrals to secondary care are being made. Tertiary care is principally of two types depending on patients’ prognosis: chronic care or rehabilitation. In addition to the three care levels, there are two parts with quite different roles: pharmacies provide pharmaceuticals, and sickness benefit schemes compensate the sick for their income losses. A recurrent policy challenge is to make each provider level take into account the resource implications of their isolated decisions outside of their own budgets. A brief discussion is included on the scope for ‘internal markets’.

scholarly journals Seroprevalence of antibodies to SARS-CoV-2 in healthcare workers: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e043584 ◽  
Author(s):  
Joseph E Ebinger ◽  
Gregory J Botwin ◽  
Christine M Albert ◽  
Mona Alotaibi ◽  
Moshe Arditi ◽  
...  
Keyword(s):  
African American ◽  
Los Angeles ◽  
Delivery System ◽  
Healthcare Workers ◽  
Los Angeles County ◽  
Healthcare Delivery ◽  
Healthcare Delivery System ◽  
Hispanic Ethnicity ◽  
Factors Associated ◽  
African American Race

ObjectiveWe sought to determine the extent of SARS-CoV-2 seroprevalence and the factors associated with seroprevalence across a diverse cohort of healthcare workers.DesignObservational cohort study of healthcare workers, including SARS-CoV-2 serology testing and participant questionnaires.SettingsA multisite healthcare delivery system located in Los Angeles County.ParticipantsA diverse and unselected population of adults (n=6062) employed in a multisite healthcare delivery system located in Los Angeles County, including individuals with direct patient contact and others with non-patient-oriented work functions.Main outcomesUsing Bayesian and multivariate analyses, we estimated seroprevalence and factors associated with seropositivity and antibody levels, including pre-existing demographic and clinical characteristics; potential COVID-19 illness-related exposures; and symptoms consistent with COVID-19 infection.ResultsWe observed a seroprevalence rate of 4.1%, with anosmia as the most prominently associated self-reported symptom (OR 11.04, p<0.001) in addition to fever (OR 2.02, p=0.002) and myalgias (OR 1.65, p=0.035). After adjusting for potential confounders, seroprevalence was also associated with Hispanic ethnicity (OR 1.98, p=0.001) and African-American race (OR 2.02, p=0.027) as well as contact with a COVID-19-diagnosed individual in the household (OR 5.73, p<0.001) or clinical work setting (OR 1.76, p=0.002). Importantly, African-American race and Hispanic ethnicity were associated with antibody positivity even after adjusting for personal COVID-19 diagnosis status, suggesting the contribution of unmeasured structural or societal factors.Conclusion and relevanceThe demographic factors associated with SARS-CoV-2 seroprevalence among our healthcare workers underscore the importance of exposure sources beyond the workplace. The size and diversity of our study population, combined with robust survey and modelling techniques, provide a vibrant picture of the demographic factors, exposures and symptoms that can identify individuals with susceptibility as well as potential to mount an immune response to COVID-19.

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