Leaving a mark on healthcare delivery with operations analysis

In the Dutch context, we see similar problems as outlined in Green’s (2012) commentary and also an increased interest by healthcare providers to use operations analysis to confront them. In this commentary, we provide our take on the same problems to extend the discussion and to highlight additional areas for consideration. Furthermore, we discuss recent projects to provide further examples of how operations analysis can be applied within these problem areas. Through this discussion, we aim to emphasize how operations analysis can be applied in a scientific, practical, and relevant way in the healthcare domain. Given that many review papers question whether the promised contribution of applying operations analysis is being achieved in healthcare (Lagergren 1998) and because reporting implementation results is rarely done in journal articles (Katsaliaki and Mustafee 2011), we feel there is a need for such a discussion. As with the U.S. healthcare system, as described by Green, the Netherlands also has an issue of “poor quality and wasteful expenditures.‿ This came to a head in 2006, when the country passed the Healthcare Insurance Act. The Act completely reformed the structure of healthcare delivery with the intent to use competition to breed efficiencies and improve value-for-money. To ensure that all Dutch citizens have the same basic level of health insurance regardless of ability to pay, a number of regulatory elements were introduced. However, significant competition was created at the same time and at two different levels. Competition exists between health insurance companies, which vie for enrollees, and healthcare providers (new and existing), which vie for contracts with health insurance companies. Insurance companies compete mainly by offering extended coverage packages (e.g., additional dentistry, eye-wear, cosmetic surgery, alternative medicine) at lower prices. Healthcare providers compete mainly on the remuneration amounts per diagnosis related group (paid by insurers to providers) and quality of care (e.g., access times, treatment options). The crucial underpinning of this system is to use competitive markets and insurance companies to force a higher performing and a more cost-effective healthcare system. The extent to which this is working can be debated; however, the concept is generally lauded (Seddon 2008). As is more directly related to this commentary, it has been our experience that this new competition has applied significant pressure on healthcare providers, which has, as a result, significantly increased the use of (and demand for) quantitative analysis. In the following sections, we discuss specific projects that have addressed problems related to the three “big problem areas‿ outlined by Green. Whereas Green reports on “what should be done,‿ the focus of this paper is on “what is being done‿ in the Netherlands, with particular attention paid to its impact on hospital operations. For each problem area, we provide our interpretation and use recent projects as examples to further illustrate how operations analysis can be applied. In the final section, we “sum up‿ our thoughts and provide summary insights.