International Journal of Healthcare Technology and Management (15 papers in press)
A scenario-based approach for master surgery scheduling under uncertainty
by S.A. MirHassani, F. Hooshmand, A. Akhavien
Abstract: Operating room planning is an important task for the hospital management authorities to improve the quality of health care under limited medical and financial resources. The aim of this study is to develop an optimal cyclic allocation table in which operating room blocks are allocated to surgeons. The emphasis is on minimising the expected bed shortage in the intensive care unit and wards, where the number of patients operated by each surgeon, the length of stay for each patient and the number of available beds in hospitalisation units are uncertain. Therefore, a scenario-based, two-stage, stochastic model on a large scenario space is proposed. Then, the sample average approximation method is employed to solve the problem for a number of randomly sampled scenarios. Numerical experiments demonstrate that the solutions obtained by this method converge to a real optimum with a moderate sample size in a reasonable time. Moreover, even for small sample sizes, the solution quality is better than other methods, such as expected value approach.
Keywords: master surgery schedule; bed shortage in hospitalisation units; scenario-based stochastic problem; scenario generation; sample average approximation.
The attitude of Greek society to public private partnerships in the public health sector
by Georgios Chatzipoulidis, George Aretoulis, Glykeria Kalfakakou
Abstract: The National Health Service (NHS) of Greece was founded in 1983 and today appears out of date. The need for reengineering the NHS is undeniable. Public Private Partnerships (PPPs) are examined as a possible funding tool, along with the critical success factors for such an implementation. The research focus was on the social reaction of Greek society towards implementation of PPPs in the public health sector. This was considered extremely important, because previous attempts to implement PPPs in various construction projects were met with intense opposition from the citizens, and as a result, the projects were not realised. A structured questionnaire survey took place. There were 500 recorded responses. The sample selection aimed to cover representative regions of Greece. The effort to collect the available data was enormous. Usually elderly participants and people who were not aware of the PPPs completely refused to participate in the survey. Descriptive statistics and correlation analysis focusing on place of residence, age, and gender, were implemented, using SPSS. Both approaches appear to lead to the same conclusions. Respondents indicated that a positive social reaction was found towards the involvement of the private sector in providing specific support services during the contract. On the other hand, there is a great reluctance, or complete refusal, to involve the private sector in any service related to the direct provision of curative care to the patients in public hospitals.
Keywords: public private partnerships; Greek National Health Service; health infrastructure; critical success factors; public acceptance.
Multi-level determinants of tele-healthcare innovations: an Italian case study.
by Sabina De Rosis, Sara Barsanti
Abstract: The objective of this research paper is to identify and describe factors influencing the implementation and scaling-up of tele-healthcare innovations. The project design was a case study, exploring tele-healthcare solutions in primary care or continuity of care in the region of Tuscany (Italy). A multi-level and multi-stakeholder sample of 32 informants was in-depth interviewed about topics based on a previous literature analysis. Crucial determinant factors in the management of tele-healthcare services were identified in relation to technological, individual, organisational and contextual aspects. A restructuration of healthcare organisations towards participative dynamics of teamwork, as well as collaborative culture, was indicated as a potential solution. A collaborative interrelationship within and among healthcare organisations, and with other stakeholders, may contribute to tele-healthcare integration into the practice, which is also strongly influenced by leadership and strategic vision, which implies the understanding that tele-healthcare is change.
Keywords: tele-healthcare; determinants; stakeholders’ perspective; re-organisation; tele-medicine; scaling-up; deployment; change management; innovation management; health technology.
A healthy lifestyle app for older adults with diabetes and hypertension: a usability assessment
by Jenna Smith-Turchyn, Janelle Gravesande, Gina Agarwal, Dee Mangin, Dena Javadi, Jessica Peter, Fiona Parascandalo, Lisa Dolovich, Julie Richardson
Abstract: Risk factor modification interventions using mobile health technology have been shown to be effective in managing non-communicable lifestyle-related conditions. The objective of this study was to explore how older adults with type 2 diabetes and hypertension use an online app developed to help manage these conditions. Usability testing was conducted on the TAPESTRY-CM Healthy Lifestyle app, an online self-management application. This included an online session, using a cognitive interviewing approach, and semi-structured interviews at various times. Qualitative content analysis was performed as sessions were completed using coding and category formation. All participants commented positively on the app content. Suggestions for improvement were given with regard to app content and layout. This study provides strong support for initial use of this app. Results will be used to improve the app prior to conducting larger scale effectiveness trials or using it in clinical practice.
Keywords: usability assessment; older adults; healthcare technology; self-management; non-communicable lifestyle-related conditions; type 2 diabetes; hypertension; healthy lifestyle app; cognitive interviewing; qualitative content analysis.
Ontology driven meta-modelling of clinical documents
by Shreya Banerjee, Anirban Sarkar
Abstract: In recent days, distinct healthcare information systems use and exchange electronic clinical documents frequently. This creates the necessity of specifying uniform semantic interpretation of clinical documents and their contents. Further, modern technology, such as connected home monitoring devices, should incorporate contextual awareness into clinical documents. Besides this, todays healthcare domain is driven by emergence of new roles, which are played by stakeholders related to that domain. Thus, effective semantic representations of clinical documents include not only the shared conceptualisation of clinical contents, but also evolving contexts and roles of stakeholders. Existing standards for representation of clinical documents fail to absorb these criteria. Thus, healthcare information systems require achieving common interpretation of clinical documents so that (1) those can be exchanged among healthcare information systems meaningfully, and (2) a personalised document view in a specific context can be achieved effectively. To address these issues, in this paper, an ontology driven meta-model for clinical documents is proposed. The proposed meta-model is represented in mathematical logic, which may facilitate reasoning on clinical knowledge. The novelty of the proposed work is to represent uniform formal conceptualisation of clinical documents. This proposed conceptualisation may fulfil a customised document view based on the demands of stakeholders in a specific context that may change with time. Consequently, the proposed work helps in meaningful exchange of clinical documents between healthcare information systems, and hence provides efficient representations of clinical decision system specifications. Further, the proposed conceptualisation is implemented in an ontology editorial tool Prot
Keywords: clinical document; ontology driven; semantic interoperability; uniform interpretation; meta-modelling; middle level ontology.
Towards a model of emergency department congestion
by Malcolm Brady, Vikas Kumar, P.J. Byrne, Gerry Conyngham, Paul Liston, Peadar Gilligan
Abstract: The purpose of this paper is to examine the flow of patients through the emergency department of a large suburban acute general hospital and the factors that influence overcrowding and congestion. The paper broadly draws on the input-process-output systems paradigm as a basis for examining emergency department patient throughput. A dataset of all attendances at the emergency department of a large suburban acute general hospital during the course of a full calendar year was examined using statistical tools. The analysis found that the major influencers of length of stay were patient-related factors such as age, severity of ailment (triage category), and whether or not the patient was admitted into the main hospital. Patients admitted into the hospital had significantly longer length of stay in emergency than those who were not admitted. The main influencers of patient arrivals were temporal factors such as time of day and day of arrival. These influencing factors are formed into a tentative model of emergency department congestion.
Keywords: emergency department; age; length of stay; throughput; congestion; patient admission; hospital.
Special Issue on: The Demand and Supply of Healthcare in China
China and Europe networks in health. An empirical analysis on co-publications
by Lauretta Rubini, Chiara Pollio
Abstract: China formally opened its economy in 1979, with the launch of the open door policy. The heart of this process has been knowledge acquisition, strongly pushed by the government mainly through incentives to collaborations with foreign firms and institutions. However, in more recent years, problems of long-term sustainability have started to be raised, especially on the necessity to couple the economic growth with an increase in the well-being of the population. Health is a pivotal sector in terms of impact on life quality of the population, as testified by the plethora of studies aimed at measuring the health-related quality of life. For this reason, to deepen the knowledge of the factors and the dynamics regulating enhancements in this field has become particularly relevant. Progress in health directly derives from progress made in scientific research, and publications are a widely recognised tool for the divulgation of knowledge in this field. In this framework, this paper analyses the evolution of international cooperation of Chinese institutions in health-related scientific fields, measured in terms of co-publications. Changes in Chinas position in the international scientific literature will be traced, focusing then on the current structure of co-authorships with the first five EU countries in terms of GDP and highlighting differences in the weight, the structure and the degree of complexity of the relation networks.
Keywords: co-publications; health; China.
Focusing on the Chinese health industry: an empirical enquiry on the TCM listed firms. Is large and private beautiful?
by Marco R. Di Tommaso, Stefano Bonnini, Qi Yue
Abstract: Traditional Chinese medicine (TCM) is a key part of the Chinese healthcare system, and TCM industries might play a growing role in the domestic and in the international markets. This work focuses on TCM listed companies in China. In particular, we study the effect of ownership and size on corporate performance. Multivariate permutation tests on the effects of ownership and size on corporate performance show that, among the TCM listed companies, private companies perform better than state-owned ones, while big companies perform better than small ones. Moreover, the study shows that in TCM industry ownership has stronger effects than size on corporate performance.
Keywords: traditional Chinese medicine industry; listed firms; corporate ownership; corporate size; corporate performance.
Value chain building and business model in the mobile device healthcare industry: the case of China
by Jie (Catherine) Zhang
Abstract: Although the mobile device healthcare (MDH) industry is developing fast, people do not have a deep understanding of its value chain, and further, its business model. This paper analyses the development of the MDH industry in China, then clarifies the total market scale of MDH. The paper then discusses key segments in the value chain of the MDH industry and unveils the business model of MDH firms. After that, the change brought by the mobile devices for the traditional healthcare industry is investigated. Finally, six cases of mobile device healthcare firms in China are raised and discussed in detail.
Keywords: mobile device healthcare industry; business model; value chain; China.
Perceptions of health technology assessment knowledge translation in China: a qualitative study on HTA researchers and policy-makers
by Yan Wei, Raymond W. Pong, Lizheng Shi, Jian Ming, Meng Tang, Yiwei Mao, Wenbin Liu, Yingyao Chen
Abstract: Although health technology assessment (HTA) has existed in China since the 1980s, the integration of HTA and policy-making is still in its infancy. Knowledge translation (KT) can play an important role in facilitating evidence-based policy-making. A number of factors affect the extent of success of KT, and this study aims to describe the process of KT from researchers to policy-makers and to identify the main determinants of the use of HTA evidence in policy-making as perceived by health policy-makers and researchers in China. Twenty-one HTA researchers and 17 health policy-makers took part in in-depth interviews. Qualitative data from the interviews were collected, organised, and coded. Grounded theory methodology was used to analyse and interpret the data. Researchers and health policy-makers perceptions of HTA KT were thus identified. In the analysis, some quantitative data were also used. A theoretical framework consisting of four domains emerged to represent researchers and policy-makers perceptions of KT from HTA to policy-making. The KT process emerged as the central domain in the framework. Health policy-makers and researchers identified several determinants of KT, including HTA KT processes, alignment between research and decision-making and features of HTA research and health decision, communication between policy-makers and HTA researchers, and support and resources for KT (organisational support, researchers and health policy-makers personal relationships and macro environment support).
Keywords: health technology assessment; knowledge translation; policy-making; China.
Chinese expansion in the international healthcare markets: the role of Chinese OFDI in Europe
by Francesca Spigarelli, Ping Lv
Abstract: The paper sheds light on the increasing interest of Chinese firms operating in key Healthcare (HC) sectors into Europe. After a description of the economic and policy context for HC in China, we perform an analysis on location choice by Chinese firms, updated to 2014, within Europe. A MofCom database of greenfield and non-greenfield Chinese investments abroad is used. We depict a map of where to where of home province vs. host country involved in the integration of Chinese and European Healthcare industries. Both spatial localisation, and motivations of Chinese investments in Europe are examined, for the following sub-sectors: pharmaceutical, medical devices and equipment, and biotechnology. Research and policy implications conclude the paper.
Keywords: healthcare industry; Chinese foreign direct investments; spatial implications.
China's future healthcare system: what role for private production and financing?
by Ake Blomqvist, Jiwei Qian
Abstract: In China, the private sector may make healthcare markets more competitive, thereby improving affordability, increasing the supply and quality of healthcare services, and improving the accessibility to health care. It can also improve financial coverage via private health insurance, as a substitute for or complement to government plans. However, strict regulation, insurance designation bias against private hospitals, insufficient risk-management capacity, and crowding out by social health insurance have hampered private sector involvement in healthcare services production and insurance. We argue that the best option at China's current state of development may be a compromise model in which competing private providers are given an important role, but in which the government intervenes in such a way as to attain both a high degree of equity of access to health care, and to avoid the most significant forms of market failure in an unregulated private system.
Keywords: health insurance; healthcare service provision; private sector; China.
China's strategic sectors:trends in health-related manufacturing
by Elisa Barbieri, Mattia Tassinari
Abstract: This paper is a first attempt to understand how strategic the health industry is for the Chinese economy, with respect to other manufacturing sectors. We measure this by building a composite indicator able to monitor over time the contribution of the different manufacturing sectors to the overall economic performance of China. In particular, we define the strategic significance of the different manufacturing sectors according to their ability to stimulate entrepreneurship, generate employment, generate capital accumulation, meet market demand, generate profits, and produce fiscal revenues. Results suggest a good and stable contribution of the health-industry filiere to the Chinese economy. They also point to a relevant and increasing contribution of specific sub-sectors, including traditional Chinese medicine and proprietary Chinese medicine.
Keywords: health industry; strategic sectors; manufacturing; composite indicator; China.
China's legal framework for pharmaceutical products: challenges and opportunities for EU companies
by Pamela Lattanzi, Federica Monti, Xu Zhao
Abstract: It is unanimously recognised in the literature that although the Chinese pharmaceutical market offers huge opportunities to European industry, it poses several challenges regarding compliance with the laws governing this sector. Because of the different legal traditions, a peculiar public health history and culture, and a different system of healthcare, EU companies faced many barriers in accessing Chinese pharmaceutical market over the years. In order to contribute to better understand the Chinas regulatory landscape and its emerging trends, the article focuses on three critical legal topics, which are relevant for the business of EU pharmaceutical companies in the Chinese market: drug registration, drug distribution system, and IP rights protection.
Keywords: China; drug registration – imported drug – new drug – generic drug – pharmaceutical distribution - wholesale - retail - pharmaceutical manufacture - cross-border sales – patent – trademark – trade secret – foreign investment.
Chinese pharmaceuticals: does sub-national marketization matter? Evidence of cross-province acquisitions by Guangdong firms
by Manli Huang, Huiru Zhang, Antonio Angelino
Abstract: This article assesses the influence of sub-national marketisation on the equity share choice in mergers and acquisitions. Focusing on domestic acquisitions in China, we examine the relationship between marketisation of the target firm and the acquirer firms equity share choice by Guangdong (GD) firms in pharmaceuticals. Our sample consists of 53 domestic acquisitions in China, of which acquirers are located in GD province and targets are located all over China. Findings confirm that differences exist in equity share choice based on different sub-national marketisation within China. Sub-national marketisation has significant association with equity share in cross-province acquisitions. An acquirer will more likely opt for partial shares in the acquired firm than full shares when acquiring a firm across-province.
Keywords: sub-national marketisation; mergers and acquisitions; equity share; pharmaceuticals.