Department of Healthcare Management University of Cologne
Healthcare Management:
Topics and Methods
„Ludwig Kuntz“
1993 – 1995 Executive for Information Management at the University Hospital of Mainz
1995 – 2002 Head of Controlling at the University Hospital of Hamburg
1.4.2002 – Professor for Business Administration and Healthcare Management
Healthcare Management
Content of the Talk
1. Question
2. Healthcare Management and Health Economics 3. Healthcare Management: Faults and Methods
- Examples „Operations Research“
- Examples „General Business Administration “
4. Situation Analysis (Teaching and Research)
Healthcare Management
Question
What is Healthcare Management?
Healthcare Management = Health Economics?
Which methods are used? What are topics?
Relevant literature…?
Healthcare Management
Economics
(state, system financing, insurance companies,…)
Management
(executives, hospitals,
Medicine
(doctors, nurses, treatment,…)
Healthcare Management: A particular perspective!
Healthcare Management
Healthcare Management
Economic Perspective – Fundamental Papers
Arrow K. J; Uncertainty and the Welfare Economics of Medical Care, The American Economic Review, 1963.
Shleifer A.; A theory of yardstick competition, Rand Journal of Economics, 1985.
Dranove D.; Rate-Setting by diagnosis related groups and hospital specialization, Rand Journal of Economics, 1987.
Ellis R. E., McGuire T.G.; Provider behaviour under
prospective reimbursement , Journal of Health Economics, 1986
Economic Perspective – Fundamental Papers
• failure of the market
• price regulation should depend on the costs
• consideration of DRG-based reimbursement
• risk of reducing quality
• risk of patient selection
Healthcare Management
Medical Perspective – Topics and Methods
• health status measurement
• assigning values to health states
• cost – benefit – analysis (CBA)
• cost – effectiveness – analysis (CEA)
• cost – utility – analysis (CUA)
Healthcare Management
Medical Perspective – Topics and Methods
Example (Eddy,1990):
Healthcare Management
$10.101
$184.500 $262.800
$1.100.000
$0
$200.000
$400.000
$600.000
$800.000
$1.000.000
$1.200.000 Cost per Year
of Life Saved for Different
Frequencies of Sreening
4 Years 3 Years 2 Years 1 Year
Sreening ervery
Management Perspective – A long MS/OR Tradition
State of the art: „Operations-Research and Health Care – A Handbook of Methods and Applications“, 2004 (Ed.: A.L.Brandeau, F. Sainfort, W.P. Pierskalla)
Content: 3 categories
1.Public policy and economic analysis 2.Clinical applications
3.Health care operations management
Healthcare Management
Management Perspective – A long MS/OR Tradition
State of the art: „Operations-Research and Health Care – A Handbook of
Methods and Applications“ (Ed.: A.L.Brandeau, F. Sainfort, W.P. Pierskalla)
Public policy and economic analysis + Clinical applications
• Modeling Health Outcomes, Treatment for Opiate Addiction, HIV, pedriatic immunization, Kidney Allocation,…
• Modeling medical treatment, medical decision analysis, anesthesia patient risk reduction, Asthma policy model, radiotherapy treatment planning…
Healthcare Management
global
individuel
Management Perspective – A long MS/OR Tradition
State of the art: „Operations-Research and Health Care – A Handbook of Methods and Applications“ (Ed.: A.L.Brandeau, F. Sainfort, W.P. Pierskalla)
Content: 3 categories
1.Public policy and economic analysis 2.Clinical applications
3.Health care operations management
Healthcare Management
Output (e.g. cases DRG)
Input (e.g. budget, investments)
hospital Efficiency
Management Perspective – Method 1: „DEA“
Healthcare Management
Erroneous thinkung: Comparisons are not possible!
Management Perspective – Method 1: „DEA“
Healthcare Management
i i
i
i
E
C
x g
x g
Input Output
⋅ = +
=
1⋅
1 2 2{
n}
i
i
E E
E E
,..., max
1*
=
1
2 3
0,00 50,00 100,00 150,00 200,00 250,00 300,00
0,00 50,00 100,00 150,00
cases (internal)
Management Perspective – Method 2: „Queues/Simulation“
Erroneous thinkung: Decisions are based on averages!
Healthcare Management
Distrubution of Occupancy
0 2 4 6 8 10 12 14
0%- 10%
11%- 20%
21%- 30%
31%- 40%
41%- 50%
51%- 60%
61%- 70%
71%- 80%
81%- 90%
91%- 100%
days per month
Management Perspective – Method 3: „ Linear Programming“
Erroneous thinkung: More is better!
Healthcare Management
DRG B
(0;500)
Intensive care unit
operating theatre
(500;200)
profit
Management Perspective – Method 3: „Linear Programming“
Case Mix Optimization with „Budget constraint“ (Germany)
Healthcare Management
billings
earnings
budget
costs
break even 1 break even 2
Management Perspective – Method 4: „MAUT“
Erroneous thinkung: Rational decisions are not possible!
System of different objectives!
Healthcare Management
„good“ company profit,…
quality,…
satisfaction,…
Management Perspective – Method 4: „MAUT“
System of different objectives! (Kleinmuntz/Kleinmuntz)
Healthcare Management
16,90%
100 Market Share
Strategic
8,60%
50 Information Integration
Strategic
7,60%
45 Physician Relationships
Quality
11,90%
70 Patient Outcomes
Quality
12,70%
75 Patient / Family Satisfaction
Quality
8,50%
50 Facility Quality
Quality
16,90%
100 Resource Efficiency
Financial
16,90%
100 Present Value
Financial
Weights Score
Attribute
Objective
Management Perspective – Method 4: „MAUT“
Erroneous thinkung: Rational decisions are not possible!
Example:
Healthcare Management
100 50 50 % quality
50 0 20 % satisfaction NPV
+/- 0 € + 500 Tsd. €
30 %
x-ray unit 0,60
Information 0,55
system
Value
weight
Management Perspective – Method 5: „Portfolio Management“
Erroneous thinkung: Every department is the best!
Healthcare Management
attractivity of market
rel. position in question
marks stars
cash cows dogs
internal medicine
surgery
obstetrics
Management Perspectice – Situation Analysis
(Michael Carter ; Diagnosis: Mismanagement of resources-Ailing health care system desperately needs a dose of operations research, so why aren‘t more OR professionals responding to the emergency, OR/MS Today – 2002 )
„Health care is a business like no other“
• multiple decision-makers with conflicting goals
• Control by goverment or insurance companies
• Politicians and advocacy groups try to influence
Healthcare Management
Healthcare Management
Management Perspectice – Situation Analysis
Share "Healthcare Management"
0,28%
6,49%
0,00%
2,00%
4,00%
6,00%
8,00%
