Essays in Healthcare Operations
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This dissertation includes three essays, which address significant issues that healthcare practitioners throughout the world face today. The fundamental research that I first address is a research agenda for reimbursement impacts upon healthcare operations management. The purpose of the first essay is to offer conceptual frameworks that portray the fundamental architecture of the U.S. healthcare system and its connections to healthcare reimbursement systems. The research method involves inductive theory development. I contend such frameworks are useful for healthcare operations management research. Using the frameworks, this essay suggests promising research opportunities that should stimulate emerging research themes in the healthcare industry and in academic healthcare operations research. These findings furnish a research agenda with timely insights for practitioners and academia. One conclusion of the essay is the lack of prior research relevant to healthcare reimbursement processes and their impacts on healthcare operations. The essay also concludes that key research opportunities relate to reimbursement boundaries, reimbursement strategy, reimbursement resources, reimbursement impacts, and reimbursement technology. In the second essay, I examine how scheduling policies can improve healthcare quality and doctor efficiency in outpatient healthcare facilities. The purpose is to develop an outpatient appointment scheduling approach under situations of patient no-shows and patient heterogeneity. Based on detailed analytical and simulation methods, the essay evaluates and compares the performance of my approach against several outpatient scheduling policies under various scenarios, and provides advice regarding optimal policies for outpatient clinics. The findings show that my proposed scheduling algorithms show efficient scheduling performance relative to prior proposed policies. In short, the findings of the second essay provide new applicable scheduling polices for outpatient scheduling. The findings also derive qualitative implications for clinic schedulers for improving the most effective way of scheduling outpatient operations. The conclusion is that the proposed scheduling approach can be potentially useful for outpatient facilities. Finally, the third essay empirically examines how managerial operational responses of hospitals vary in response to external pressures imposed upon them by government policies. The purpose is to examine whether hospitals respond to such policies by improving operating processes and quality outcomes, or by gaming their response by adjusting patient case mixes and other metrics associated with financial benefits for the hospital, instead of operational improvement. To validate whether hospitals respond suitably to an ongoing U.S. government quality improvement program, called the Value Based Purchasing (VBP) program, I explore how the program influences subsequent behaviors of U.S. hospitals. Using observational data from the Center for Medicare & Medicaid Services (CMS) and several other sources, I use regression analysis methods to provide empirical evidence of the effects of this government policy. The essay findings show that financially penalized hospitals use tactics consistent with symbolic practices, which may be an unintended outcome from the VBP project. The conclusion is that theoretically motivated contextual differences exist in the behaviors of hospitals when facing these external government pressures.
Lee, Seung Jun (2016). Essays in Healthcare Operations. Doctoral dissertation, Texas A & M University. Available electronically from