An Efficient Decision-Making Approach for the Planning of Diagnostic Services in a Segmented Healthcare System

2019 ◽  
Vol 18 (05) ◽  
pp. 1631-1665 ◽  
Author(s):  
Rodolfo Mendoza-Gómez ◽  
Roger Z. Ríos-Mercado ◽  
Karla B. Valenzuela-Ocaña

In this paper, we address a decision-making problem related to the requirement of costly equipment by medical diagnostic services in a segmented public healthcare system comprising several institutions and private providers. The problem is motivated by a real-world case of the Mexican healthcare system. The aim of this study is to determine which hospitals can provide the service, their capacity levels, the allocation of demand in each institution, and the referral of patients to other institutions or private providers while minimizing annual investment costs and operating costs required to satisfy demand. A mixed-integer linear programming model that takes into account different characteristics such as patient acuity levels, types of equipment, and demand variation through time is introduced. The model was empirically assessed to evaluate its impact on the decision-making process. A sensitivity analysis to evaluate solution behavior for variations of critical parameters was performed. The results showed that some values could generate a significant effect on the total costs for the service coverage and in the efficiency of the service, whereas overall results indicated the usefulness of the model. While this model is valuable to aid this decision-making problem, it is limited to medium-size instances of up to 90 facilities. To solve the problems with larger instances, a two-phase heuristic algorithm is proposed. In the first phase, the method uses a greedy construction mechanism, and in the second phase, it attempts to improve the solution. Empirical evidence on large instances shows that good solutions with low computing times are reached in comparison with the exact method.

Author(s):  
Karolina Napiwodzka

The aim of the paper is to reconsider Habermas’ discourse approach in terms of its usefulness in the realm of public healthcare where, on a microscale, intersubjective communicative situations arise between defined participants, i.e., patients and healthcare providers, patients’ family members, and further eligible contributors to patient-related decision making. A need for more “communicative interaction,” and explicative and practical discourse, is illustrated by two empirical examples of medical decision making which reveal both communicative and discursive deficits (Section I). To empower and enable the patient as a rational and autonomous speaker and discourse participant, a Habermasian emancipatory argument and ‘the power of the better argument’ is recalled (Section III). The possibility of equal communicative and discursive rights in the light of real inequalities is discussed in the context of a ‘competence gap’ between participants (Section IV). Further sections focus on the importance of informed consent on the side of the patient and the communicative competences as an important factor of healthcare system.


2021 ◽  
Author(s):  
Fernando Hayashi Sant'Anna ◽  
Ana Paula Muterle Varela ◽  
Janira Prichula ◽  
Juliana Comerlato ◽  
Carolina Baldisserotto Comerlato ◽  
...  

South Brazil has been the novel epicenter of Coronavirus Disease 2019 (COVID-19) in 2021, accounting for the greatest number of cumulative cases and deaths (per 100 thousand inhabitants in a week) worldwide. In this study, we analyzed 340 whole genomes of SARS-CoV-2, which were sampled between April and November 2020 in 33 cities in South Brazil. We demonstrated the circulation of two novel emergent lineages, described here as P.4 and P.4.1 (provisionally termed VUI-NP13L), and seven lineages that had already been assigned (B.1.1.33, B.1.1.28, P.2, B.1.91, B.1.1.94, B.1.195 and B.1.212). P.2 and P.4.1 demonstrated massive spread from approximately September/October 2020. Constant and consistent genomic surveillance is crucial to identify newly emerging SARS-CoV-2 lineages in Brazil and to guide decision making in the Brazilian Public Healthcare System.


2017 ◽  
Vol 24 (2) ◽  
pp. 561-584 ◽  
Author(s):  
Baris KECECI ◽  
Tusan DERYA ◽  
Esra DINLER ◽  
Yusuf Tansel IC

In selecting the best mixed integer linear programming (MILP) formulation the important issue is to figure out how to evaluate the performance of each candidate formulation in terms of selected criteria. The main objective of this study is to propose a systematic approach to guide the selection of the best MILP formulation among the alternatives according to the needs of the decision maker. For this reason we consider the problem of “selecting the most appropriate MILP formulation for a certain type of decision maker” as a multi-criteria decision making problem and present an integrated AHP-TOPSIS decision making methodology to select the most appropriate formula­tion. As an example the proposed decision making methodology is implemented on the selection of the MILP formulations of the Capacitated Vehicle Routing Problem (CVRP). A numerical example is provided for illustrative purposes. As a result, the proposed decision model can be a tool for the decision makers (here they are the scientists, engineers and practitioners) who intend to choose the appropriate mathematical model(s) among the alternatives according to their needs on their studies. The integrated AHP-TOPSIS approach can simply be incorporated into a computer-based decision support system since it has simplicity in both computation and application.


2018 ◽  
Vol 28 (5) ◽  
pp. 1489-1496
Author(s):  
Branislav Stanisavljević

Research carried out in the last few years as the example of companies belonging to the category of medium-size enterprises has shown that, for example, typical enterprises, of the total number of data processed in information of importance for its business, seriously takes into consideration and process only 10% of the observed firms. It is justifiable to ask whether these 10% of the processed and analyzed business information can have an adequate potential or motive power to direct the organization to success that is measured by competitive advantages and on a sustainable basis? Or, the question can be formulated: what happens to the rest, mostly 90% of the information that the enterprise does not transform into a form suitable for business analysis and decision-making. It is precisely the task of business intelligence to find a way to utilize all the data collected and processed in the business decision-making process. In this regard, we can conclude that Business Intelligence is, in fact, the framework title for all tools and / or applications that will enable the collection, processing, analysis, distribution to decision-making bodies in the business system in order to derivate from this information valid business decisions - as the most important and / or most important task of the manager. Of course, from an economic point of view, the best decisions are management decisions that provide a lasting competitive advantage and achieve maximum financial performance. This means that business intelligence actually allows a more complete and / or comprehensive view of the overall business performance of all its parts and subsystems. But the system functions can be measured essential and positive economic and financial performance, as well as the position in the branch of the business to which it belongs, and wider, within the national economy. (Of course, today the boundaries of the national economy have become too crowded for many companies, bearing in mind globalization and competitiveness in the light of organization of work and business function). The advantage of business intelligence as a model, if accepted at the organization level, ensures that each subsystem in the organization receives precisely the information needed to make development decisions, but also decisions regarding operational activities. So, it should be born in mind that business intelligence does not imply that information is shared on some key words, on the contrary, the goal is to look at the context of the business, or in general, and that anyone in the further decision hierarchy can manage exactly the same information that is necessary for achieving excellent business performance. Because, if the insight into the information is not complete, the analysis is based on the description of individual parts, i.e. proving partial performance in the realization of individual information, which can certainly create a space for the loss of the expensive time and energy. Illustratively, if the view, or insight into the information, is not 100%, then all business decision-making is like the song of J.J. Zmaj "Elephant", about an elephant and a blindmen, where everyone feels and act only on the base of the experienced work, and brings judgment on what is what or what can be. As in this song for children, everyone thinks that he touches different animals and when they make claims about what they feel, everyone describes a completely different life. Therefore, business intelligence implies that information is fully considered and it is basically the basis or knowledge base, and therefore the basis of business excellence. In doing so, the main problem is how information is transformed into knowledge and based on it in business decision making. It is precisely in this segment that the main advantage of business intelligence is its contribution to the knowledge and business of the company based on power of knowledge. Therefore, for modern business conditions, it is characteristic that the management of the company is realized on the basis of partial knowledge about stakeholders (buyers, suppliers, competitors, shareholders, governments, institutional framework, legislation), and only a complete overview of managers at the highest level in all these partial interest groups allows managers to have a “boat” called the organization of labor leading a safe hand through the storm, Scile and Haribde threatens to endanger business, towards a calm sea and a safe harbor - called a sustainable competitive advantage based on power and knowledge.


2021 ◽  
Vol 11 (4) ◽  
pp. 1660 ◽  
Author(s):  
Ivan Marović ◽  
Monika Perić ◽  
Tomaš Hanak

A way to minimize uncertainty and achieve the best possible project performance in construction project management can be achieved during the procurement process, which involves selecting an optimal contractor according to “the most economically advantageous tender.” As resources are limited, decision-makers are often pulled apart by conflicting demands coming from various stakeholders. The challenge of addressing them at the same time can be modelled as a multi-criteria decision-making problem. The aim of this paper is to show that the analytic hierarchy process (AHP) together with PROMETHEE could cope with such a problem. As a result of their synergy, a decision support concept for selecting the optimal contractor (DSC-CONT) is proposed that: (a) allows the incorporation of opposing stakeholders’ demands; (b) increases the transparency of decision-making and the consistency of the decision-making process; (c) enhances the legitimacy of the final outcome; and (d) is a scientific approach with great potential for application to similar decision-making problems where sustainable decisions are needed.


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