Date of Completion

8-9-2019

Embargo Period

8-9-2019

Keywords

Healthcare Management, Precision Medicine, Database Evolution, Medication Theory Management, Emergency Department, Queuing Theory, Affordable Care Act

Major Advisor

Manuel A. Nunez

Associate Advisor

Stephanie A. Gernant

Associate Advisor

Lynn Kuo

Associate Advisor

Xue Bai

Field of Study

Business Administration

Degree

Doctor of Philosophy

Open Access

Open Access

Abstract

The healthcare industry is growing fast and its services have an intense effect in human lives, thus providing the need and opportunity for improvement by using operations and information management methodologies. In this dissertation, we research three emerging issues regarding the healthcare industry. First, we consider the economics of precision medicine (PM) treatments. PM is a surging healthcare field consisting of a set of high-cost complex medical procedures that provide targeted treatments according to the individual characteristics of each patient. We develop a cost-benefit decision model of a patient undergoing PM treatments to assess learning curve effects in cost reduction through interaction with a centralized database repository. We also develop a simulation model to study the dynamics of the PM approach and discuss insights derived from this model.

In our second essay, we research operational aspects in the implementation of MTM (Medication Therapy Management) services. MTM is a recently developed set of services provided by community pharmacies aiming to optimize drug therapy and improve therapeutic outcomes of medication-controlled conditions in patients through a direct counselling and follow-up from pharmacists. We formulate queuing and simulation models of a community pharmacy’s workflow to optimize delivery of MTM services. We consider metrics such as the profitability of the pharmacy, the service rate, and the welfare of patients. Using our models, we determine conditions when economies of scope should be realized, how to redesign workflows, and how to improve capacity management.

Finally, in our third essay, we conduct an empirical analysis to study the apparently recent decline of emergency departments across the U.S. We consider operational causes for this phenomenon and the effect from changes in the insurance industry such as the evolution of the Affordable Care Act in recent years. We find that contrary to what some hospitals have reported, competition is not the main reason for the closure of their emergency departments. States with a declining number of emergency departments are more sensitive to the change of the hospitals’ financial situation and availability of medical resources.

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