|Institution:||University of North Carolina – Chapel Hill|
|Full text PDF:||http://dc.lib.unc.edu/u?/etd,5318|
Current spending in the US health system has reached 17.9% of GDP and the need for improved decision-making to help lower costs and improve quality is widely recognized. This dissertation, Operating on Quality, Access, and Cost: Managing Better Health Systems takes a hierarchical approach to effective healthcare decision-making by examining three broad areas for healthcare improvement: health systems design, health systems maintenance, and clinical operations. We examine how effective operational strategies for improving health service delivery take into account interrelationships between quality, access, and cost of care. At the design level, we employ competitive queueing models to study the impact of inter-provider competition on quality, wait-time and social welfare. At the maintenance level, we use queueing network analysis to study the relationship between screening guidelines and capacity planning for colorectal cancer. At the operations level, we employ stochastic modeling to analyze appointment allocation policies to improve outpatient clinics' responsiveness to patients' needs.