Healthcare Warranty Policies Optimization for Chronic Diseases Based on Delay Time Concept.

Heng Zhao,Mei Li,Lijun Liang,Zixian Liu

doi:10.3390/healthcare9081088

Abstract

Warranties for healthcare can be greatly beneficial for cost reductions and improvements in patient satisfaction. Under healthcare warranties, healthcare providers receive a lump sum payment for the entire care episode, which covers a bundle of healthcare services, including treatment decisions during initial hospitalization and subsequent readmissions, as well as disease-monitoring plans composed of periodic follow-ups. Higher treatment intensities and more radical monitoring strategies result in higher medical costs, but high treatment intensities reduce the baseline readmission rates. This study intends to provide a systematic optimization framework for healthcare warranty policies. In this paper, the proposed model allows healthcare providers to determine the optimal combination of treatment decisions and disease-monitoring policies to minimize the total expected healthcare warranty cost over the prespecified period. Given the nature of the disease progression, we introduced a delay time model to simulate the progression of chronic diseases. Based on this, we formulated an accumulated age model to measure the effect of follow-up on the patient’s readmission risk. By means of the proposed model, the optimal treatment intensity and the monitoring policy can be derived. A case study of pediatric type 1 diabetes mellitus is presented to illustrate the applicability of the proposed model. The findings could form the basis of developing effective healthcare warranty policies for patients with chronic diseases.

Highlights

Hospital readmissions have received substantial worldwide attention in recent years
We proposed a systematic optimization model of a healthcare warranty policy that allows healthcare providers to determine the optimal combination of treatment decisions and disease-monitoring policies to minimize
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Summary

Introduction

Hospital readmissions have received substantial worldwide attention in recent years. According to a report, over 17% of patients were readmitted within 30 days of discharge [1]. Under the bundled payment (BP) system, the hospital will receive a lump sum for a whole episode of care, including index admissions and readmissions that occur over a specified warranty period, such as 90 days after discharge, regardless of the treatment details and the possible related complications [12]. Some scholars hold that healthcare warranty payments contribute to a higher quality of healthcare and keep treatment costs under control because patients would no longer pay for hospital readmissions when they occur [9,15]. Providing a high level of treatment services to the patient during index admission may increase the profit margins by reducing the probability of readmissions under healthcare warranty payments [16]. This study is intended to provide an effective medical service decision-making model to enrich disease management research

Objectives

Findings

Discussion

Conclusion