Healthcare Facilities’ Congestion Risk Under Air Pollution And Adaptation Measures

Ambient air pollution is a major environmental risk to human health around the world,responsible for 4.5 million deaths a year.Although many countries have adopted policies to regulate air pollution levels,the World Health Organization reports that more than 90%of the world’s population currently still live in areas where air pollutant concentrations exceed guideline limits.Under these circumstances,numerous studies have assessed the health risk and disease burden attributable to ambient air pollution.However,it is still unclear how air pollution can further impact healthcare operations and how to help healthcare facilities adapt to the stress of air pollution.To fill the above research gap,this dissertation examines how air pollution can increase healthcare congestion risk and offers corresponding adaptation measures.Overcrowding in healthcare facilities is a big problem faced by healthcare operations management worldwide,whether in developing or developed countries.According to the input-throughput-output conceptual model,the sources of congestion risk can be summarized as too many admitted patients in the input component,too long length of stay in the throughput component,and too low discharge efficiency in the output component.Therefore,this dissertation studies the healthcare congestion risk under air pollution and adaptation measures from three aspects:patients’ admission,patients’ length of stay,and patients’ discharge.Firstly,using the medical insurance data from a province in China,this dissertation investigates the influence of air pollution on the number of patients admitted to healthcare facilities.Empirical analyses show that air pollution significantly increases the number of admissions,but only for non-primary healthcare facilities which are more likely to experience overcrowding.For those primary healthcare facilities,there is no evidence that air pollution could increase admissions.In addition,further moderating analyses show that the government’s disclosure of air pollution information could not moderate the relationship between air pollution and admission,while the public’s online search for air pollution related information has a negative moderating effect.These findings indicate that air pollution could increase healthcare facilities’ congestion risk in the input component by increasing the number of admitted patients,especially for non-primary healthcare facilities.Meanwhile,policymakers should help healthcare facilities cope with this impact by taking measures to facilitate the public’s searching behavior for air pollution information,instead of only relying on information disclosure.Secondly,using the data from a tertiary hospital’s cardiothoracic intensive care unit in Singapore,this dissertation examines the effect of air pollution on patients’length of stay in healthcare facilities.Empirical analyses show that air pollution significantly lowers doctors’ work performance,thus leading to patients’ longer length of stay in the intensive care unit.This finding indicates that air pollution could increase healthcare facilities’ congestion risk in the throughput component.Additionally,further mechanism analyses suggest that the negative psychological impact of air pollution is a potential mechanism for doctors’ poorer performance on polluted days.Meanwhile,based on the mediating effect of guideline adherence and the non-linear moderating effect of workload observed in mechanism analyses,managers could help healthcare facilities address the impact of air pollution on the throughput component by taking measures to enhance doctors’ adherence to guidelines and adjust their workload.Finally,using the data from a grade-A tertiary hospital’s respiratory department in China,this dissertation studies the impact of air pollution on patients’ discharge efficiency in healthcare facilities,mainly focusing on readmission.Readmission means that patients are readmitted to the hospital within several days after discharge.Since readmission decreases the number of discharged patients actually,it indicates low discharge efficiency.Empirical analyses show that air pollution significantly increases patients’ readmission risk,but patients’ preventive behavior like face mask wearing could mitigate this effect.These findings indicate that air pollution could increase healthcare facilities’ congestion risk in the output component by decreasing patients’ discharge efficiency,while policymakers and managers could help healthcare facilities handle this impact by taking measures to enhance patients’preventive behavior after discharge.This dissertation has several theoretical and practical contributions.From the perspective of literature,this dissertation bridges the literature on environmental health and healthcare operations management:(1)Extending the literature on the health effects of air pollution by further investigating the impact of these health effects on healthcare congestion;(2)Contributing to the empirical research in healthcare operations management by highlighting the importance of environmental factors(i.e.,ambient air pollution),complementing well-known medical variables and operational factors.From the perspective of practice,this dissertation helps healthcare facilities keep effective operation under air pollution,enhancing the resilience of healthcare systems:(1)Helping healthcare facilities understand how air pollution can increase congestion risk by affecting patients’ admission,length of stay,and discharge;(2)Providing possible directions and decision supports for policymakers and managers in the healthcare sector to develop air pollution adaptation measures.