Essays in Telehealth Services Management


Student thesis: Doctoral Thesis

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Awarding Institution
Award date15 Nov 2022


Cost, quality, and access, which comprise “Iron Triangle” of healthcare, cannot be improved simultaneously in the traditional manner. However, with the aid of telehealth, healthcare providers can increase access to high-quality service while reducing care-delivery costs for patients, especially in remote areas. To this end, two types of telehealth modes exist in our country: One is the telehealth platform built by the Internet company. It recruits independent physicians during their spare time to serve patients in exchange for the payment. The other is the Internet hospital constructed by the public hospital, which is government owned and is fully funded by the government. Through remote medical consultation and medical alliance coordination, the Internet hospital allows community hospitals to increase their medical capacities. In turn, however, the question of how to better manage these telehealth modes has become crucial to both healthcare managers and academic researchers. As such, this thesis employs the telehealth platform and the Internet hospital as examples to study the operations management in telehealth.

This thesis consists of three essays: The first essay focuses on the operations management of the telehealth platform and the government’s reimbursement issue. The platform hires independent physicians with wages. Physicians are wage sensitive. Each of them will decide whether or not to join the platform, according to the wage and his or her own opportunity cost. On the demand side, patients are delay- and quality-sensitive. Once patients arrive, they will decide whether or not to request the medical service, based on their utilities. This essay models the strategic behaviours of both patients and physicians in order to derive the optimal decisions (e.g., service price, wage, and service rate) of the revenue-maximizing telehealth platform. Afterwards, this essay investigates the impact of the physician’s opportunity cost heterogeneity and the customer intensity of the service provided on the platform’s optimal decisions. Continuing, this essay studies the social optimum and compares it with the market equilibrium. Meanwhile, this essay also investigates how the government’s reimbursement policy influences the system equilibrium and social welfare.

The second essay studies the queue configuration of the telehealth platform. The market features two types of physicians − namely, high-quality and low-quality. The high-quality physician generates a higher fixed service value for patients. The telehealth platform can gather all those physicians in one pooled queue. However, this subsequently creates service-value uncertainty, due to the mix of two types of physicians. This queue configuration is referred to as the pooled queue. Beyond this, the platform can also divide physicians into different types and provide differential services. This queue configuration is referred to as the dedicated queue. This essay analyses the impact of the service value difference and the proportion of high-quality physicians on the platform’s choice of the queue configuration (pooled or dedicated queue). To this end, the essay first obtains the platform’s optimal decisions in these two systems separately and analyses the impact of different parameters. After that, this essay compares the performance of the two queue configurations regarding important dimensions such as the total arrival rate, the participating physicians’ total surplus, the platform’s profit, and social welfare.

The third essay investigates the contract design problem of the telehealth referral system consisting of the Internet hospital. When a patient requires advance care outside of the community hospital's expertise, the community hospital refers the patient to the Internet hospital, built by the tertiary hospital. A tertiary referral hospital is a hospital that provides tertiary care, which is a level of health care obtained from specialists in a large hospital after referral from the providers of primary care and secondary care. With the aid of an online physician, patients may be cured locally. If the online treatment fails, patients will be referred to the tertiary hospital's offline department. Both hospitals can exert efforts to improve the treatment outcome with effort costs. This essay constructs the telehealth referral system and analyses its performance. To this end, it first obtains the social optimum and then compares it against both hospitals’ effort decisions in different payment schemes. To achieve the social optimum, this essay proposes a new contract. Through some numerical experiments, this essay illustrates the inefficiency of two common payment contracts (i.e., fee-for-service, bundled payment contracts). In the end, this essay extends the basic model and studies when it is better to introduce the Internet hospital.

    Research areas

  • Telehealth, Strategic queueing, Operations management, Contract design