Essays on healthcare-delivery innovation

Delana, K (2019) Essays on healthcare-delivery innovation. Doctoral thesis, University of London: London Business School.

Abstract

Accessibility is both a fundamental prerequisite for providing high-quality healthcare, and a core challenge for healthcare providers. To improve accessibility in the face of growing demand without increasing costs, hospitals and health systems are developing innovative service delivery models. However, the impact of such efforts is dependent upon the response of patients; in other words, whether patients choose to adopt new models of service delivery. This thesis presents the analysis of two healthcare service delivery innovations designed to improve accessibility, with a focus on the response of patients and implications for practice. The first study empirically examines the impact of rural telemedicine centers on patient accessibility to an ophthalmic hospital system in Southern India. We find that telemedicine centers improve access, particularly for "simple" patients whose visit rates increase approximately twice as much as "complex" patients. This contributes to increased rates of glasses prescriptions for "simple" patients, while no increase is observed in the rate at which surgeries are preformed for "complex" patients. This shows that the new telemedicine-based service delivery model increases access for all patients, but that the benefits are not uniform due to heterogeneous patient adoption. The second study is inspired by an antenatal ward aiming to reduce delays for patients undergoing induction of labor. Management was considering asking patients to be flexible by agreeing to start the procedure up to a day early if there was available bed capacity, i.e., proactive service. We find that despite large potential reductions in delays, patients are far less likely to adopt proactive service than is desirable. This happens because fl exibility generates positive externalities which incentivizes free-riding on the flexibility of others. This shows that to capture the benefits of patient flexibility through a proactive service delivery model patients may need to be incentivized to overcome the economic frictions.