Richard Janssen

Application of lean thinking to health care: issues and observations

Background Incidents and quality problems are a prime cause why health care leaders are calling to redesign health care delivery. One of the concepts used is lean thinking. Yet, lean often leads to resistance. Also, there is a lack of high quality evidence supporting lean premises. In this paper, we present an overview of lean thinking and its application to health care. Development, theory and application of lean thinking to health care Lean thinking evolved from a tool designed to improve operational shop-floor performance at an automotive manufacturer to a management approach with both operational and sociotechnical aspects. Sociotechnical dynamics have until recently not received much attention. At the same time a balanced approach might lead to a situation where operational and sociotechnial improvements are mutually reinforcing. Application to health care has been limited and focussed mainly on operational aspects using original lean tools. A more integrative approach would be to pay more attention to sociotechnical dynamics of lean implementation efforts. Also, the need to use the original lean tools may be limited, because health care may have different instruments and tools already in use that are in line with lean thinking principles. Discussion We believe lean thinking has the potential to improve health care delivery. At the same time, there are methodological and practical considerations that need to be taken into account. Otherwise, lean implementation will be superficial and fail, adding to existing resistance and making it more difficult to improve health care in the long term.

Impact of Electronic Auctions on Health Care Markets

Electronic auctions can be applied in certain markets, but the effects on market structure, market behaviour and market performance are unclear. We analysed the effects of a reverse electronic auction initiative, implemented by a new intermediary (CareAuction.nl), on the market for maternity care in the Netherlands in 2005 and 2006. After an unsuccessful start in 2004 as cybermediary in the care market between patients and care providers, CareAuction successfully moved in March 2005 to the care contracting market between insurance companies and care providers. We report on the effects of CareAuction on market performance (price of maternity care minus 2-4%), market structure (more care providers involved in the bidding processes) and market behaviour (bidding behaviours and user preferences). We conclude that IT and cybermediation result in the evolution of electronic markets, influenced by complex interactions among market structure, market conduct and market performance.

E-business in health care : Does it contribute to strengthen consumer interest?

One of the goals of the reforms in the European health-care systems over the last two decades has been to make the health-care system more demand-oriented. There is not much known about the possible impact of E-business like approaches on this goal. This paper describes the concept of E-business. Two cases are introduced to illustrate the use of a simple E-business approach in a health-care setting. On the basis of these case studies, we aspect a reduction of the information disadvantages of patients. In our analysis, we also apply new institutional economy concepts, namely agency theory and transaction costs economics to focus on the position of the patient. Concluded is that it is more probable that preferences of demanders are answered by the suppliers of health care.

Privatisation in health care: concepts, motives and policies

Over the last decade privatisation has been used frequently as a policy instrument to reduce the financial burden of the public sector. In most countries there is a mix of public and private interests in health care. Because of this, privatisation is an important issue in health care policy analysis. In this article we deal with different concepts and motives for privatisation in general. We will distinguish various types of privatisation and show how these can be applied to changes in health care policy. As far as the latter is concerned we will use Dutch experiences. In the analysis we emphasise especially the effects of privatisation in health care on the private non-profit organizations.

Evaluation of the organization and financing of the Danish health care system

The organization and financing of the Danish health care system was evaluated within a framework of a SWOT analysis (analysis of strengths, weaknesses, opportunities and threats) by a panel of five members with a background in health economics. The evaluation was based on the reading of an extensive range of documents and literature on the Danish health care system, and a 1-week visit to health care authorities, providers and key persons. The present paper describes the main findings of one of the panel members. A quality assessment approach is combined with the principles of a SWOT analysis to assess the main features of the Danish health care system. In addition, a public health perspective has been used in judging the coherence of the subsystems of the health systems. It is concluded that the macro-efficiency of the health care system could be increased by improving the cooperation between the subsystems. The relatively high mortality rates suggest that greater input into health education programs could significantly improve the health status of the Danish population. Finally, it is suggested that the steering power of the public board be strengthened by transferring ownership of health care institutions to other hands (privatization).

Hospital management by product lines.

Over the last decennium many reforms of the reimbursement systems have taken place to improve the economic performance of health service organizations. These environmental changes have stimulated many hospital managers to introduce types of internal management control. Consequently budgeting is a very well known management tool. Less known in Europe is product-line management. The main purpose of this article is to introduce the concept of product-line management. Attention is paid to ways product lines can be defined in hospitals and which elements the implementation of product-line management envelope. Emphasis is laid on the consequences for the organizational structure and the cost information system. Finally, we deal with the advantages and disadvantages of product-line management.

Association of Cost Sharing With Mental Health Care Use, Involuntary Commitment, and Acute Care

Importance A higher out-of-pocket price for mental health care may lead not only to cost savings but also to negative downstream consequences. Objective To examine the association of higher patient cost sharing with mental health care use and downstream effects, such as involuntary commitment and acute mental health care use. Design, Setting, and Participants This difference-in-differences study compared changes in mental health care use by adults, who experienced an increase in cost sharing, with changes in youths, who did not experience the increase and thus formed a control group. The study examined all 2 780 558 treatment records opened from January 1, 2010, through December 31, 2012, by 110 organizations that provide specialist mental health care in the Netherlands. Data analysis was performed from January 18, 2016, to May 9, 2017. Exposures On January 1, 2012, the Dutch national government increased the out-of-pocket price of mental health services for adults by up to &OV0556;200 (US

Factors associated with hospital closure and merger: A survival analysis of Dutch hospitals from 1978 to 2010

226) per year for outpatient treatment and &OV0556;150 (US

Bureaucracy Versus Markets in Hospital Care: The Dutch Case

169) per month for inpatient treatment. Main Outcomes and Measures The number of treatment records opened each day in regular specialist mental health care, involuntary commitment, and acute mental health care, and annual specialist mental health care spending. Results This study included 1 448 541 treatment records opened from 2010 to 2012 (mean [SD] age, 41.4 [16.7] years; 712 999 men and 735 542 women). The number of regular mental health care records opened for adults decreased abruptly and persistently by 13.4% (95% CI, −16.0% to −10.8%; P < .001) per day when cost sharing was increased in 2012. The decrease was substantial and significant for severe and mild disorders and larger in low-income than in high-income neighborhoods. Simultaneously, in 2012, daily record openings increased for involuntary commitment by 96.8% (95% CI, 87.7%-105.9%; P < .001) and for acute mental health care by 25.1% (95% CI, 20.8%-29.4%; P < .001). In contrast to our findings for adults, the use of regular care among youths increased slightly and the use of involuntary commitment and acute care decreased slightly after the reform. Overall, the cost-sharing reform was associated with estimated savings of &OV0556;13.4 million (US

A cost-effectiveness analysis to evaluate a system change in mental healthcare in the Netherlands for patients with depression or anxiety

15.1 million). However, for adults with psychotic disorder or bipolar disorder, the additional costs of involuntary commitment and acute mental health care exceeded savings by &OV0556;25.5 million (US