Management Problems in Health Care

303 Pages·1988·6.179 MB·English

by  Kurt Heidenberger (auth.), Professor Dr. Günter Fandel (eds.)

Gunter Fandel (Ed.)
Management Problems
in Health Care
With 29 Figures and 43 Tables
Springer-Verlag
Berlin Heidelberg New York
London Paris Tokyo
Professor Dr. Gunter Fandel
Lehrstuhl fUr Betriebswirtschaft
Fernuniversitat Hagen
FeithstraBe 140
5800 Hagen 1, FRG
ISBN 978-3-642-73672-8 ISBN 978-3-642-73670-4 (eBook)
DOI 10.1007/978-3-642-73670-4
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Preface
The treatment and the solution of health economic problems by using
management concepts is a permanent challenge; the question of control
ling the costs or the efficiency of the supply of medical services is
concerned. The articles in this book hope to make a concrete contri
bution to this subject by reporting on the latest research the authors
have made in this area.
The medical services involved can either be part of the general provi
sion of medical care and treatment to the population or can be provided
by hospitals which are complex systems of public health care. The divi
sion of the contents of this book reflects this distinction. The four
articles in Part A are concerned with problems of general health care.
Part B is dedicated to particular problems relating to hospital planning
and contains five articles.
In Part A the first article by Heidenberger deals with 'Optimal Resource
Allocation in Horizontally and Vertically Disaggregated Health Programs'
Using corresponding model formulations and linear programming the pro
blem is solved of how a fixed budget should be distributed among the
measures of a social health program so that the control of an illness
is as effective as possible. In the case in question the illness to
be controlled is high blood pressure. The possibilities for using this
type of approach in health programs to combat other illnesses are ob
vious. The generalized approach developed by the author makes it easier
to handle these problem situations and to solve them with less restric
tive assumptions than forerunners of this approach. Feucht and Ostheimer
examine 'Micro-Economic Aspects of Magnetic Resonance Tomography'. MR
tomographic scanners belong to the high technology of medical equipments,
and can discover and recognize particular illnesses faster and more
reliable than ever before. At the same time they are also very complex
systems with a great demand for personnel and space, cause considerable
investment costs, and are subject to rapid technological changes given
the present medical-technical progress. The purchase of an MR tomographic
scanner by a doctor or a hospital is so bound up with high amortization
risks. Questions on the most favourable configuration, on the develop
ment of the numbers of patients and cases for examination, on costs
and proceeds and even on the break-even-point of such an investment
practically suggest themselves. The authors attempt to offer suitable
VI
answers to the many different questions in this area. 'Regional Location
and Capacity Planning for ESW Lithotripters and CT Scanners' is the
subject of Bach's article. Using renal lithotripters and CT scanners
as examples the author shows how a model of operating and transportation
costs can be used to support decisions as to the purchasing and operation
of machines for advanced medical technology. The model can be used to
support the systematic compilation of the planning options which can
be found with AMT machines or should be taken into account. Furthermore,
the consequent effects of an AMT machine as regards costs, and in medical
and spatial respects, can be illustrated with the model. Starting point
for the considerations is the assumption that within this context single
AMT machines must be observed in relation to other AMT machines in a
metropolitan area of a region or in a Federal State. Fandel and Prasiswa's
analysis of 'Planning and Organization of Economic Units in the Field
of Out-Patient Medical Care' is concerned with the problem of optimal
unit size, organization forms and inputstructure for a doctor's practice
depending on the number of patients to be treated. A linear output
oriented production model with various procedural possibilities is dis
cussed as an approach to the solution. The methodical considerations
are then applied to an ophthalmologist's practice and the results shown.
Part B begins with an article from Hansen on 'Outcome Based Hospital
Financing and Decision Oriented Hospital Management ',in order to provide
hospital services on an optimal cost basis while simultaneously maximizing
the profit of the hospital. This conflict situation seems to be solved
best by formulating a convex programming problem with a saddle point
as optimal solution. A second concern of Hansen's work are the flows
of information between the wards and the functional areas. The tradi
tional organizations make considerable mistakes in data transmission,
which a computer-based system of information processing can greatly
reduce. In Fandel's contribution 'Special Problems of Recource Planning
in Hospitals' three different problem areas are discussed on the basis
of corresponding literature surveys. These are: location planning for
different functional areas in a hospital, personnel scheduling in wards
and departments on a minimum cost basis, and the stocking of easily
perishable goods such as X-ray materials and blood plasma. The article
from Fandel and Schmidt deals with 'Approaches to the Planning of the
Optimal Supply of Beds in Hospitals '. Almost 90% of total costs in a
hospital can be interpreted as fixed costs in that, given existing
VII
capacity, they are directly determined by the number of available beds
and accrue independently of how many patients are actually treated. Be
cause of this, examination as to the numbers of beds on offer in exi
sting hospitals and the optimal organization of their supply are of
great importance. The article gives first a survey of the approaches
in the literature on this subject. An important aspect here is how the
hospital's admission policy treats urgent and non-urgent cases. The
non-admittance rate for urgent cases and the waiting times for non
urgent cases are fundamental determinants of an optimal bed supply.
A new recommendation for a solution is developed from the criticism
of the approaches in the literature in order to determine the optimal
numbers of regular and emergency beds in a hospital. The solution prin
ciple and the algorithm used are illustrated by means of a practical
case. Fandel and Hegemann's work 'On Capacity Planning of Diagnosis
Systems in Hospitals' shows how the queueing theory, extended by ele
ments of the stochastic network technique, can be used in the capacity
and process planning of complex diagnosis systems in hospitals. The
model developed is, in contrast to approaches used up to now in the
literature, a generalization on two patient flow systems, inpatients
and outpatients, which run through the diagnostic system for examination
purposes. The methodical considerations are supplemented by a study
of a practical case in which the attempt is made to use the analytical
considerations for the purpose of improving capacity utilization and
patient flow in the diagnostic areas of the Hagen General Hospital.
In the final contribution in Part B from Stahly the theme is 'Simulation
Models for the Analysis of Hospitals with Regard to their Emergency
Infrastructure '. A hospital model is presented which allows the simula
tion of the actual reaction of a hospital service in extreme emergencies,
such as natural or technical catastrophes, in regard to optimal capacity
utilization. With the help of suitable choice of parameters small, medium
sized and large hospitals can be studied in such situations. The importan
point is to organize the hospital's stand-by services and the reactions
of its management in such a way that in extreme cases no capacity is
wasted. The analysis of the results of the simulations forms the basis
for the derivation of rules for decision-making and for emergency plans
as to how problems in hospitals during catastrophes should be mastered.
Finally, I would like to take the opportunity of thanking all those
who supported and assisted in the publication of this book. I would
like to thank the authors for their articles and for their generous
cooperation. I would particularly like to thank the Fernuniversitat
VIII
for its considerable support. I would like to thank Gabriele Dahl,
Christiane Kocherscheidt, Manuela Kutschinski, Lioba Lanwer, Thomas
Giersiepen and Frank Reh for their extreme patience in preparing the
manuscripts for printing.
Hagen, March 1988 GUnter Fandel
Table of Contents
PART A: PROBLEMS OF GENERAL PROVISION WITH MEDICAL SERVICES 1
1. Optimal Resource Allocation in Horizontally and 3
Vertically Disaggregated Health Programs
Kurt Heidenberger
2. Micro-Economic Aspects of Magnetic Resonance Tomo 31
graphy
Hildegard Feucht and Ernst Ostheimer
3. Regional Location and_ Capacity Planning for ESW 69
Li thotripters and CT Scanners
LUder Bach
4. Planning and Organization of Economic Units in 113
the Field of Out-Patient Medical Care
GUnter Fandel and Antonius Prasiswa
PART B: PROBLEMS IN HOSPITAL PLANNING 139
5. Outcome Based Hospital Financing and Decision 141
Oriented Hospital Management
Klaus Hansen
6. Special Problems of Resource Planning in Hospitals 159
GUnter Fandel
7. Approaches to the Planning of the Optimal Supply 189
of Beds in Hospitals
GUnter Fandel and Erhard Schmidt
8. On Capacity Planning of Diagnosis Systems in Hos 235
pitals
GUnter Fandel and Holger Hegemann
9. Simulation Models for the Analysis of Hospitals 263
with Regard to their Emergency Infrastructure
Paul Stahly
LIST OF CONTRIBUTORS 297
Part A: Problems of General Provision with Medical Services
Optimal Resource Allocation in Horizontally and Vertically
Disaggregated Health Programs
Kurt Heidenberger
Introduction
A health program can be disaggregated horizontally and vertically. A
program is called horizontally disaggregated if different diseases or
different measures for the same disease are considered for disjoint popu
lations or population strata. Stratification criteria may be e. g. age,
sex, social class or geographical area. Within each stratum we allow for
a vertical program disaggregation, i. e. each stratum-specific activity
is split up into a stochastic sequence of steps. Given a fixed amount of
resources the policy question is how to allocate them between the strata
and within each stratum between the successive stages of the stochastic
decision tree in order to maximize overall program effectiveness. Program
effectiveness is usually measured in terms of "additional health"; we
don't discuss the measurement problems involved but refer to the litera
ture (Brooks 1986).
Among the worldwide most well-known health programs are the hypertension
detection and reduction programs in the United States of America. Hyper
tension, i. e. high blood pressur~ there affects about one in six adults.
It is the single most important risk factor in cardiovascular disease,
the leading cause of death in the United States as well as in several
other industrialized countries, e. g., in the Federal Republic of Ger
many which has a hypertension prevalence of 17 % too. The causes