Search

Background: Constrained optimization methods are already widely used in health care to solve problems that represent traditional applications of operations research methods, such as choosing the optimal location for new facilities or making the most efficient use of operating room capacity.Objectives: In this paper we illustrate the potential utility of these methods for finding optimal solutions to problems in health care delivery and policy. To do so, we selected three award-winning papers in health care delivery or policy development, reflecting a range of optimization algorithms. Two of the three papers are reviewed using the ISPOR Constrained Optimization Good Practice Checklist, adapted from the framework presented in the initial Optimization Task Force Report. The first case study illustrates application of linear programming to determine the optimal mix of screening and vaccination strategies for the prevention of cervical cancer. The second case illustrates application of the Markov Decision Process to find the optimal strategy for treating type 2 diabetes patients for hypercholesterolemia using statins. The third paper (described in Appendix 1) is used as an educational tool. The goal is to describe the characteristics of a radiation therapy optimization problem and then invite the reader to formulate the mathematical model for solving it. This example is particularly interesting because it lends itself to a range of possible models, including linear, nonlinear, and mixed-integer programming formulations. From the case studies presented, we hope the reader will develop an appreciation for the wide range of problem types that can be addressed with constrained optimization methods, as well as the variety of methods available.Conclusions: Constrained optimization methods are informative in providing insights to decision makers about optimal target solutions and the magnitude of the loss of benefit or increased costs associated with the ultimate clinical decision or policy choice. Failing to identify a mathematically superior or optimal solution represents a missed opportunity to improve economic efficiency in the delivery of care and clinical outcomes for patients. The ISPOR Optimization Methods Emerging Good Practices Task Force's first report provided an introduction to constrained optimization methods to solve important clinical and health policy problems. This report also outlined the relationship of constrained optimization methods relative to traditional health economic modeling, graphically illustrated a simple formulation, and identified some of the major variants of constrained optimization models, such as linear programming, dynamic programming, integer programming, and stochastic programming. The second report illustrates the application of constrained optimization methods in health care decision making using three case studies. The studies focus on determining optimal screening and vaccination strategies for cervical cancer, optimal statin start times for diabetes, and an educational case to invite the reader to formulate radiation therapy optimization problems. These illustrate a wide range of problem types that can be addressed with constrained optimization methods. [ABSTRACT FROM AUTHOR]

Abstract: The establishment of specific and thoroughly researched criteria to evaluate hospitals’ activity is very important because there is a huge and increasing amount of public resources dedicated to healthcare. Therefore, it is necessary to design a system to evaluate healthcare performance in order to discover and improve potential inefficiencies. With this goal in mind, the purpose of this paper is to analyse efficiency in three healthcare service units in Valencian hospitals to establish appropriate guidelines for efficiency performance. Three healthcare service units of 22 hospitals in the Valencian Community (East Spain) with a waiting list higher than average were selected (general surgery, ophthalmology, traumatology–orthopaedic surgery). In this study, a non-parametric methodology, known as the DEA model (Data Envelopment Analysis), was used along with two efficiency indexes which were specially designed. Discriminant analyses proved the effectiveness of these two indexes, therefore the indicators are an easier and effective methodology for measuring efficiency than the DEA Model. In addition, the discriminant analysis offers a function which classifies new health services as efficient or inefficient. In conclusion, this paper offers tools for evaluating the performance of hospital activity which are useful for both hospital management and health administration controlling hospital performance. [ABSTRACT FROM AUTHOR]

In developing countries, including India, the role of the private sector in the provision of basic healthcare services is gradually expanding, since the public sector provides limited services and covers only limited areas. Using location-allocation models (LAM), this paper (1) examines the changing geographic access to and locational efficiency of basic public healthcare vis-a`-vis private healthcare services in two districts located in northwestern part of India, and (2) interrogates the factors that govern their geographic accessibility and locational-efficiency.Although this research confirms regional inequalities in geographic accessibility and locational efficiency of both public and private healthcare services in the selected districts, the locational efficiency of private health services is significantly lower than that of public health services. This paper further demonstrates the use of LAM for new site identification (keeping the existing healthcare sites intact) that will, in the future, improve locational efficiency of these services. This paper not only recommends improved geographic access to both public and private health services and their enhanced complementary role, but also stresses the need to evaluate geographic access from the service-users’ perspective and the use of more realistic data on demand and supply in future research. The findings of this paper can be extended to areas with similar geographic settings, and socio-economic and demographic conditions. [Copyright &y& Elsevier]

Recently, cloud computing gained an important role in healthcare services (HCS) due to its ability to improve the HCS performance. However, the optimal selection of virtual machines (VMs) to process a medical request represents a big challenge. Optimal selection of VMs performs a significant enhancement of the performance through reducing the execution time of medical requests (tasks) coming from stakeholders (patients, doctors, etc.) and maximizing utilization of cloud resources. For that, this paper proposes a new model for HCS based on cloud environment using Parallel Particle Swarm Optimization (PPSO) to optimize the VMs selection. In addition, a new model for chronic kidney disease (CKD) diagnosis and prediction is proposed to measure the performance of our VMs model. The prediction model of CKD is implemented using two consecutive techniques, which are linear regression (LR) and neural network (NN). LR is used to determine critical factors that influence on CKD. NN is used to predict of CKD. The results show that, the proposed model outperforms the state-of-the art models in total execution time the rate of 50%. In addition, the system efficiency regarding real-time data retrieval is greatly improved by 5.2%. In addition, the accuracy of hybrid intelligent model in predicting of CKD is 97.8%. The proposed model is superior to most of the referred models in the related works by 64%. [ABSTRACT FROM AUTHOR]

Background/purpose: Taiwan has one of the fastest growing aging populations in the world, which makes the effective allocation of scarce medical resources a key issue. This paper investigates patterns in the use of outpatient services by elderly individuals in Taiwan under the National Health Insurance (NHI) program.Methods: We assembled a random sample from the NHI Research Database in Taiwan, comprising 50% of all claims made for elderly people (65 years old) in 2010 (n 1,239,836 beneficiaries) including 14 variables.Results: In 2010, individuals aged 65 years or older comprised 10.74% of the population of Taiwan, and accounted for 11.39% of all physician and outpatient visits. The rate of medical care visits was 28.54 ± 21.23 (Standard deviation) times per person per annum, with a higher rate for women, those in the 80-84 age group, low-income beneficiaries, and the inhabitants of offshore islands. The three most frequent diagnoses for elderly patients were hypertension, diabetes, and acute upper respiratory infections. The mean insured medical costs per person per annum were US Dollars 1,132, with higher expenses for men, those in the 80-84 age group, and those inhabiting urban areas.Conclusion: This study employed nationally representative data in the detection of patterns in outpatient care utilization by elderly individuals in Taiwan. Medical care providers and policymakers should be fully aware of the complex patterns unique to older patients. The results of this study could be used as a benchmark with which to assess the impact of future medical care policy on elderly people. [ABSTRACT FROM AUTHOR]

This paper uses a difference-in-difference strategy to evaluate a program in Guatemala that expanded access to health services through two contracting modalities. In the contracting-out model NGOs were responsible for all administrative and clinical procedures, while in the contracting-in model NGOs focused on administrative tasks and employed public employees to provide services. The evaluation design allows comparing results across both contracting models as well as with an area that did not receive additional services. Both models achieved modest results regarding immunization coverage and prenatal care, though contracting in performed slightly better. We also compare program phases and discuss policy implications. [ABSTRACT FROM AUTHOR]

This paper outlines results from a large Australian study of migrants and a matched native-born sample on their perceptions of the quality of their cancer care. We find substantial differences in the perceived quality and propose pathways to redress this imbalance.Background Recent data show a falling cancer mortality in the general population without a similar shift in immigrant outcomes, leading to a greater cancer burden and mortality for immigrants. Our aims were to compare perceived patterns of care in immigrants and native-born cancer patients. Patients and methods This was a hospital-based sample of first-generation immigrants and Australian-born Anglo patients in the first year following diagnosis. It was restricted to Chinese, Arabic, or Greek speakers. Eligible participants, recruited via 16 oncology clinics, were over 18, with cancer (any type or stage), and having commenced treatment at least 1 month previously. Five hundred and seventy-one CALD patients (comprising 145 Arabic, 248 Chinese, and 178 Greek) and a control group of 274 Anglo-Australian patients participated. Results Immigrants had difficulty communicating with the doctor (73% versus 29%) and understanding the health system (38% versus 10%). Differences were found in ‘difficulty knowing who to see’ (P = 0.0002), ‘length of time to confirm diagnosis’ (P = 0.04), wanting more choice about a specialist and hospital (P < 0.0001); being offered the opportunity to see a counselor (P < 0.0001); and actually seeing one (P < 0.0001). There were no significant self-reported differences regarding how cancer was detected, time to see a health professional, or type first seen; however, immigrants reported difficulty knowing who to see. Previous studies showed differences in patterns of care according to socioeconomic status (SES) and educational level. Despite adjusting for age, sex, education, marital status, SES, time since diagnosis, and type of cancer, we did not find significant differences. Instead, we found that understanding of the health system and confidence understanding English were important factors. Conclusions This study confirmed that immigrants with cancer perceive an inferior quality of cancer care. We highlight potentially modifiable factors including assistance in navigating the health system, translated information, and cultural competency training for health professionals. [ABSTRACT FROM AUTHOR]

Abstract: Mobile technology has been piloted in a variety of domains. We investigate the use of smart phones in the hospital environment, as they can play an important role in the recording and exchanging of information. This paper examines how context can be characterised for developing context sensitive user interfaces for smart phone application in a hospital environment. We introduce a new characterisation of the notion of context, based on the principle of separation of the concerns that are relevant to the application domain. We coin the term context descriptor, which captures the notion of context at the end-user level, while the characterisation of the context incorporates the user model via the user stereotype. We use a sub-domain of health care, nursing services, the tasks of the nurses serving as a living example to illustrate the ideas presented. [Copyright &y& Elsevier]

This paper presents results of a research priority setting process focused on trans women living with and affected by HIV across Canada. It features data from semi-structured interviews and focus groups conducted with a diverse group of 76 trans women in five urban centers across the country on how they have navigated health and social service programming within their geographic context. The results focus on the structure and types of services. Respondents offered simple, yet creative ways to address barriers to vital services based on their individual and collective experiences. Notably, participants stressed the need for 1) trans-friendly and trans-specific services, 2) integrated health services, and aid in navigating complex, overlapping systems, and 3) comprehensive community-based services. They also suggest employing trans women as care coordinators or case managers in order to foster more trans-friendly environments and empower community members. We identify concrete ways to improve health and social services at the level of service delivery and program design, as well as recommendations for future participatory research. We close with an interrogation of trans people, and trans women living with and affected by HIV in particular, as 'hard to reach' populations. • Research with trans women yields richer insights if trans-identified experts lead. • Trans-friendly and trans-specific modes of service design and provision differ. • Integrated services are vital, but must address nuance of transgender women's needs. • Trans women are not hard to reach; rather, it is services that are hard to access. • Our trans-led community-based participatory approach can and should be reproduced. [ABSTRACT FROM AUTHOR]

Abstract: Following major reforms of the British National Health Service (NHS) in 1990, the roles of purchasing and providing health services were separated, with the relationship between purchasers and providers governed by contracts. Using a mixed multinomial logit analysis, we show how this policy shift led to a selection of contracts that is consistent with the predictions of a simple model, based on contract theory, in which the characteristics of the health services being purchased and of the contracting parties influence the choice of contract form. The paper thus provides evidence in support of the practical relevance of theory in understanding health care market reform. [Copyright &y& Elsevier]

Abstract: India has a comprehensive legal and regulatory framework and large public health delivery system which are disconnected from the realities of health care delivery and financing for most Indians. In reviewing the current bureaucratic approach to regulation, we find an extensive set of rules and procedures, though we argue it has failed in three critical ways, namely to (1) protect the interests of vulnerable groups; (2) demonstrate how health financing meets the public interests; (3) generate the trust of providers and the public. The paper reviews the state of alternative approaches to regulation of health services in India, using consumer and market based approaches, as well as multi-actor and collaborative approaches. We argue that poor regulation is a symptom of poor governance and that simply creating and enforcing the rules will continue to have limited effects. Rather than advocate for better implementation and expansion of the current bureaucratic approach, where Ministries of Health focus on their roles as inspectorate and provider, we propose that India''s future health system is more likely to achieve its goals through greater attention to consumer and other market oriented approaches, and through collaborative mechanisms that enhance accountability. Civil society organizations, the media, and provider organizations can play more active parts in disclosing and using information on the use of health resources and the performance of public and private providers. The overview of the health sector would be more effective, if Indian Ministries of Health were to actively facilitate participation of these key stakeholders and the use of information. [Copyright &y& Elsevier]

Abstract: The recent history of healthcare privatisation and corporatisation in Malaysia, an upper middle-income developing country, highlights the complicit role of the state in the rise of corporate healthcare. Following upon the country''s privatisation policy in the 1980s, private capital made significant inroads into the healthcare provider sector. This paper explores the various ownership interests in healthcare provision: statist capital, rentier capital, and transnational capital, as well as the contending social and political forces that lie behind state interests in the privatisation of healthcare, the growing prominence of transnational activities in healthcare, and the regional integration of capital in the healthcare provider industry. Civil society organizations provide a small but important countervailing force in the contention over the future of healthcare in the country. It is envisaged that the healthcare financing system will move towards a social insurance model, in which the state has an important regulating role. The important question, therefore, is whether the Malaysian government, with its vested interests, will have the capacity and the will to play this role in a social insurance system. The issues of ownership and control have important implications for governance more generally in a future healthcare system. [Copyright &y& Elsevier]

Abstract: Much of the writing on health in developing countries focuses on the public sector rather than the private market, and on providers rather than on consumers. A more consumer-oriented perspective would regard the transactions by which most people in most poor countries buy healthcare as the norm, just one among many purchases of a personal service which all of us, as consumers, have to make. This paper contends that asymmetric information is not confined to health and medicine, but is a common problem for consumers whatever the GDP of the country they live in, and however rich and poor they may be. Understanding how consumers overcome these problems yields insights into the ways in which providers have to market their services, and into what, if anything, governments and donors can do to extend, improve or regulate the private healthcare market. [Copyright &y& Elsevier]

Drug treatment programs are uniquely situated to screen patients for antibodies for hepatitis C virus (HCV), an infectious disease that has reached epidemic proportions among drug users. This paper compares the accessibility and patients’ use of opportunities for HCV antibody testing in a large sample of methadone and drug-free treatment programs (N=256) in the US, and reports programs’ recent changes and future plans concerning it. Results indicate that almost all methadone and about two-thirds of drug-free programs in the sample provided HCV antibody screening to at least some patients in 2001. While about two-thirds of the methadone and close to one-third of the drug-free programs offered this service to all patients, these programs report that only about 3/5 of their patients actually provided specimens for testing for HCV antibodies. Some drug treatment programs were planning to increase the availability and accessibility of HCV antibody screening, but others were planning to cut back on these services, primarily due to limited resources. These results can inform policymakers who advocate for increased HCV antibody screening in drug treatment programs about the current level and future plans for implementing these services, illuminating where resources and motivational efforts need to be targeted. [Copyright &y& Elsevier]

This study examines young people''s access to reproductive healthcare services via an urban youth advisory centre in Bulawayo, Zimbabwe. The aim is to explain why teenagers do not always use existing health services. Data from exit questionnaires with users and focus groups with non-users are analysed to evaluate service accessibility. Analysis suggests that even where clinics are spatially accessible, barriers to access include temporal factors, lack of factual knowledge and stigmatisation. The paper concludes that spatial accessibility is not the only factor necessary to ensure equal access to health services. Recommendations are made towards tackling young people''s unmet needs for reproductive healthcare services. [Copyright &y& Elsevier]

This paper investigates the optimal contracts for a hospital and a physician, in a model where both agents jointly participate in the production of health services. The contract design deals with two-sided moral hazard: the hospital’s investment is not observable by the insurer, and the physician’s effort is observable neither by the insurer nor by the hospital. We analyze the circumstances under which an insurer rather contracts both the hospital and the physician instead of contracting exclusively the hospital, delegating to the latter the power to contract the physician. These circumstances are related to the importance of each agent in the production. [Copyright &y& Elsevier]

The paper presents a stylised model of contracting for a specific health service. The benefit of this service differs across patients. A purchaser, National Health Service (NHS, insurer) offers a contract to providers (hospitals, GP's), under the constraint of limited information about the provider's costs and the contract specifies the payment as a function of the number of cases treated. A number of features of the optimal contract are derived. Some of these are surprising: for example, the price per case generally increases with the efficiency of the provider. [ABSTRACT FROM AUTHOR]

Objectives: To describe variation across Europe in PERISTAT indicators of health care in the perinatal period, and to assess the comparability of these indicators. Study design: The PERISTAT feasibility study provides the source for this descriptive study, covering 15 European countries. Comparative analysis includes descriptions of births following management of sub-fertility, timing of first antenatal visit, onset of labour, mode of delivery, place of birth, preterm births in units without NICU, and breast-feeding uptake. Results: There is broad variation in the availability to provide data on perinatal indicators, and in perinatal health care across the European Union. Conclusions: This paper describes the challenge of identifying indicators that are meaningful and robust for the full distribution of health care systems represented in the European Union. Further work is needed to ensure that the implementation of each indicator is comparable across member states. [Copyright &y& Elsevier]