Three essays in healthcare operations management

Operations Management can contribute greatly in understanding the various challenges currently faced by the healthcare sector worldwide including the U.S. In the three essays of this dissertation, I investigate three such challenges in diverse settings that require diverse methods of analysis.;In Chapter 1, I study the degree of concentration in the U.S. influenza vaccine market and its impact on the supply of vaccines. I show that interaction between yield uncertainty in the production process and firms' strategic behavior can contribute to a high degree of concentration in an industry and a reduction in the industry output and the expected consumer surplus in equilibrium. I analyze the social trade-off between risk pooling (by diversification of supply) and economies of scale (by avoiding duplication of fixed costs). Finally, I conduct numerical analysis with realistic parameters to assess the impact of yield uncertainty on the U.S. influenza vaccine market.;Chapter 2 presents a prescriptive model for rationing treatment for HIV+ patients in resource-constrained regions such as Asia and Africa. I consider an individual clinic facing an uncertain supply of drugs resulting from inadequate supply management skills and a weak infrastructure. I model the clinic's trade-off between improving access to treatment for new patients and providing uninterrupted treatment for current patients and derive its optimal treatment rationing policy using stochastic dynamic programming. I show that under certain conditions the optimal policy coincides with the clinically preferred policy of prioritizing previously enrolled patients. Numerical illustrations suggest that the performance of enrollment policies used in practice can be substantially suboptimal.;In Chapter 3, I examine the relationship between organizational factors and quality of care in healthcare organizations. Using the data from a QIC conducted in Ryan White CARE Act funded clinics in the U.S. and an accompanying survey of clinicians, I find that organizations with more open culture, a higher focus on QI and multidisciplinary teams attempted higher number of interventions and attempted interventions that were more cross-departmental in nature. Controlling for number of interventions and mean importance rating of interventions, implementation success was significantly associated with cross-departmental nature of interventions, fraction of interventions repeated and evaluated and presence of multidisciplinary teams. These results provide one potential explanation for the heterogeneity of implementation performance across healthcare organizations.