Developing a platform for comparison of hospital admission systems: An illustration

There is an increasing need to develop a platform for comparing hospital admission planning systems due to a shift in the service paradigm in the health sector. The current service concept of hospital admission planning aims at optimising the use of scarce hospital resources without paying much attention to the level of service offered to patients. As patients nowadays do not accept long waiting times for hospital admission, it becomes necessary to consider alternative admission service concepts. Waiting lists have also become a political issue, and alternative concepts have been advocated such as giving all patients an appointment for admission. A simulation model was built to examine the impacts of extreme admission service concepts in a simplified hospital setting. The alternative concepts considered are based on the ‘zero waiting time’ principle (immediate treatment), and the ‘booked admissions’ principle (using an appointment for admission). The results of these admission service concepts are compared with the results of the current concept, based on the ‘maximising resource use’ principle. The paper deals with the development of a framework and tool that allows evaluating different, somehow conflicting, hospital admission planning concepts and the usefulness of such framework and tool for more refined/real-life approaches to hospital admission planning.     

Selfish routing in public services

It is well observed that individual behaviour can have an effect on the efficiency of queueing systems. The impact of this behaviour on the economic efficiency of public services is considered in this paper where we present results concerning the congestion related implications of decisions made by individuals when choosing between facilities. The work presented has important managerial implications at a public policy level when considering the effect of allowing individuals to choose between providers. We show that in general the introduction of choice in an already inefficient system will not have a negative effect. Introducing choice in a system that copes with demand will have a negative effect.     

Mean and variance of waiting time and their optimization for alternating traffic control systems

We analyze alternating traffic crossing a narrow one-lane bridge on a two-lane road. Once a car begins to cross the bridge in one direction, arriving cars from the other direction must wait, forming a queue, until all the arrivals in the first direction finish crossing the bridge. Such a situation can often be observed when road-maintenance work is being carried out. Cars are assumed to arrive at the queues according to independent Poisson processes and to cross the bridge in a constant time. In addition, once cars join the queue, each car needs a constant starting delay, before starting to cross the bridge. We model the situation where a signal controls the traffic so that the signal gives a priority to one direction as long as a new car from the same direction arrives in a fixed time. For this model, we get a closed form for the first two moments of the waiting time of cars arriving at the bridge, and then numerically obtain Pareto optimal solutions of holding times to minimize the mean waiting time and its standard deviation. To the memory of our best friend, Yo Ishizuka     

Modelling hospital costs to produce evidence for policies that promote equity and efficiency

Third party payers for health care, when introducing policies to promote equity, through formulas for resource allocation by capitation, and efficiency, through prospective payment by case-mix, have sought to make adjustments for “unavoidable” hospital costs, which are caused by structural characteristics and are beyond the scope of local hospital management. To date, however, most published studies of such estimates have been inadequate. This paper reports the development of a generalisable model that aims to produce sound estimates of “unavoidable” hospital costs and shows how this stochastic multilevel model can be used to estimate unavoidable costs per unit of measurable output, identify sources of allocative inefficiency, and capture systematic variations in costs between different types of hospitals, through prospective payment by case-mix or formulas for resource allocation by capitation The application of the model to Portuguese hospitals has identified various causes of allocative inefficiencies: centrally-determined distributions of beds and doctors, a lack of local flexibility, systems with perverse incentives, and the existence of diseconomies of scale.     

Queue length and waiting time of the M/G/1 queue under the D-policy and multiple vacations

We study the steady-state queue length and waiting time of the M/G/1 queue under the D-policy and multiple server vacations. We derive the queue length PGF and the LSTs of the workload and waiting time. Then, the mean performance measures are derived. Finally, a numerical example is presented and the effects of employing the D-policy are discussed. AMS Subject Classifications 60K25 This work was supported by the SRC/ERC program of MOST/KOSEF grant # R11-2000-073-00000.     

Analysis of MAP/PH1,PH2/1 queue with vacations and optional secondary services

In this paper we study a queueing model in which the customers arrive according to a Markovian arrival process (MAP). There is a single server who offers services on a first-come-first-served basis. With a certain probability a customer may require an optional secondary service. The secondary service is provided by the same server either immediately (if no one is waiting to receive service in the first stage) or waits until the number waiting for such services hits a pre-determined threshold. The model is studied as a QBD-process using matrix-analytic methods and some illustrative examples are discussed.     

Estimating technical and allocative efficiency in the public sector: A nonparametric analysis of Dutch schools

Public sector output provision is influenced not only by discretionary inputs but also by exogenous environmental factors. In this paper, we extended the literature by developing a conditional DEA estimator of allocative efficiency that allows a decomposition of overall cost efficiency into allocative and technical components while simultaneously controlling for the environment. We apply the model to analyze technical and allocative efficiency of Dutch secondary schools. The results reveal that allocative efficiency represents a significant 37 percent of overall cost efficiency on average, although technical inefficiency is still the dominant part. Furthermore, the results show that the impact of environment largely differs between schools and that having a more unfavorable environment is very expensive to schools. These results highlight the importance of including environmental variables in both technical and allocative efficiency analysis.     

Analytical evaluation of the characteristic curve of a blood bank and its usefulness in blood banking

In this paper the characteristic curve of a blood bank (BB) for a particular blood group (BG) (which expresses the probability of ultimate wastage of a unit of blood by outdating as a function of the age of blood entering the BB) is evaluated analytically and its usefulness is examined. The application of the model developed is examined in a major teaching hospital.     

A branch and bound based heuristic for makespan minimization of washing operations in hospital sterilization services

In this paper, we address the problem of parallel batching of jobs on identical machines to minimize makespan. The problem is motivated from the washing step of hospital sterilization services where jobs have different sizes, different release dates and equal processing times. Machines can process more than one job at the same time as long as the total size of jobs in a batch does not exceed the machine capacity. We present a branch and bound based heuristic method and compare it to a linear model and two other heuristics from the literature. Computational experiments show that our method can find high quality solutions within short computation time.     

The impact of managerial and organizational aspects on hospital wards’ efficiency: Evidence from a case study

In spite of its acknowledged relevance, the impact of managerial and organizational aspects on hospital wards’ efficiency has been so far overlooked by the literature. In order to explore this issue, this paper presents a model of the relations between the decision making process of a hospital ward and its technical efficiency. In order to test the model, a two-step approach has been adopted. In the first step the technical efficiency of wards belonging to a large Italian Hospital Enterprise has been calculated using DEA. In the second step, efficiency scores have been regressed on a set of variables capturing managerial goals and actions internal to the ward, as well as re-organizations imposed by the hospital central management. Responses to a questionnaire administered to the heads of ward were used to build the independent variables. Results show that both decisions internal to the ward and exogenous re-organizations affect the ward’s efficiency, and suggest that these variables are more significant in explaining efficiency than environmental ones.     

湖南省公共医疗卫生支出效率及其影响因素实证分析

利用DEA-Tobit两阶段分析法,计算出2009-2013年5年间湖南省14个地级市政府公共医疗卫生支出的综合技术效率值、纯技术效率值、规模效率值三种效率值,分析出湖南省各地级市政府公共医疗卫生支出所处规模报酬阶段,并对反映卫生支出资金配置的综合技术效率水平的外部影响因素加以回归分析.结果发现:湖南省各地区公共医疗卫生效率水平整体水平偏低并且存在明显的差异性,除长沙以外的其他地级市政府公共医疗卫生支出均处于不同程度的非充分效率水平.湖南省各地区人均生产总值及城市化水平对公共医疗卫生支出效率有显著的促进作用.教育水平、人口密度、居民人均可支配收入对湖南省公共医疗卫生支出效率的提高有阻碍作用.     

Joint-optimization of inventory policies on a multi-product multi-echelon pharmaceutical system with batching and ordering constraints

This paper presents a methodology to find near-optimal joint inventory control policies for the real case of a one-warehouse, n-retailer distribution system of infusion solutions at a University Medical Center in France. We consider stochastic demand, batching and order-up-to level policies as well as aspects particular to the healthcare setting such as emergency deliveries, required service level rates and a new constraint on the ordering policy that fits best the hospital’s interests instead of abstract ordering costs. The system is modeled as a Markov chain with an objective to minimize the stock-on-hand value for the overall system. We provide the analytical structure of the model to show that the optimal reorder point of the policy at both echelons is easily derived from a simple probability calculation. We also show that the optimal policy at the care units is to set the order-up-to level one unit higher than the reorder point. We further demonstrate that optimizing the care units in isolation is optimal for the joint multi-echelon, n-retailer problem. A heuristic algorithm is presented to find the near-optimal order-up-to level of the policy of each product at the central pharmacy; all other policy parameters are guaranteed optimal via the structure provided by the model. Comparison of our methodology versus that currently in place at the hospital showed a reduction of approximately 45% in the stock-on-hand value while still respecting the service level requirements.