Hospital Decision Research Articles

The Impact of the Implementation of the ABC Cost Accounting System on Improving the Financial Management Decisions in Private Hospitals Operating in Jordan to Achieve Sustainable Development Goals

Objective: This study aimed to demonstrate the impact of activity-based cost accounting on improving the financial administrative decision in private hospitals operating in Jordan cost allocation as a modified variable to achieve sustainable development goals. Theoretical Framework: The private hospitals operating in Jordan need to consider the implementation of an activity-based cost system to provide the necessary infrastructure for this, as well as the availability of opportunities to measure the health service more efficiently. Method: The inductive and deductive approaches were used to indicate the activity-based cost system and the cost allocation statement, and the statistical analysis system was used to analyze and test the study hypotheses. Results and Discussion: The study has reached a set of results, the most important of which was that the activity-based cost system contributes in a way that leads to maximizing profitability and improving the financial administrative decision if applied in private hospitals operating in Jordan, and also in private hospitals operating in Jordan, the infrastructure and capabilities necessary to apply the activity-based cost system in measuring the cost of health services, Research Implications: This study highlights to demonstrate the impact of activity-based cost accounting on improving the financial administrative decisions in private hospitals operating in Jordan. Originality/value: apply the activity-based cost system in private hospitals operating in Jordan because this system contributes in a way that leads to maximizing profitability and improving the financial administrative decision if applied.

Nursing prioritization and rationing decisions in acute care hospitals during the Covid-19 pandemic: a qualitative study

Nursing prioritization and rationing decisions in acute care hospitals during the Covid-19 pandemic: a qualitative study Abstract:Background: The Covid-19 pandemic has put decisions regarding prioritization and rationing of care resources on the health policy agenda. The effects on the allocation of nursing resources in clinical practice are unclear. Aim: In order to derive implications for future pandemic situations, we analyzed the extent to which decisions were made about the distribution of resources in acute inpatient care and how bottlenecks were dealt with. Methods: We conducted semi-structured interviews with nursing staff (n = 16) and nursing team leaders (n = 10) in five acute-care clinics in Germany and analyzed them inductively using thematic framework analysis. Results: In acute inpatient care under pandemic conditions, prioritization and rationing decisions were made, such as the postponement or reduction of nursing measures, in order to overcome pandemic-specific challenges. These decisions affected certain patient groups and certain near- and distant-patient services, in particular fundamental care measures, such as support with personal hygiene and nutrition, as well as access to acute inpatient care. The decisions were made implicitly rather than according to evidence-based criteria. Conclusions: Nursing prioritization and rationing decisions were made during the pandemic. These decisions are similar to comparable decisions outside of the pandemic, particularly in terms of insufficient evidence base, and emphasize the need for empirically based decision criteria.

Automation of the medication process in Swiss hospitals: results of a survey

ObjectivesMedication management is a core process in hospital administration. The safety, timeliness and efficiency of medication distribution may be improved by automating logistical and administrative aspects of the process. Forming...

The social experience of uncertainty: a qualitative analysis of emergency department care for suspected pneumonia for the design of decision support

BackgroundThis study sought to understand the process of clinical decision-making for suspected pneumonia by emergency departments (ED) providers in Veterans Affairs (VA) Medical Centers. The long-term goal of this work is to create clinical decision support tools to reduce unwarranted variation in diagnosis and treatment of suspected pneumonia.MethodsSemi-structured qualitative interviews were conducted with 16 ED clinicians from 9 VA facilities demonstrating variation in antibiotic and hospitalization decisions. Interviews of ED providers focused on understanding decision making for provider-selected pneumonia cases and providers’ organizational contexts.ResultsThematic analysis identified four salient themes: i) ED decision-making for suspected pneumonia is a social process; ii) the “diagnosis drives treatment” paradigm is poorly suited to pneumonia decision-making in the ED; iii) The unpredictability of the ED requires deliberate and effortful information management by providers in CAP decision-making; and iv) the emotional stakes and high uncertainty of pneumonia care drive conservative decision making.ConclusionsEnsuring CDS reflects the realities of clinical work as a socially organized process with high uncertainty may ultimately improve communication between ED and admitting providers, continuity of care and patient outcomes.

Application of Gamification Teaching in Disaster Education: Scoping Review.

With climate change, the number of natural disasters is increasing globally, and the resulting weather-related events lead to increased loss of life and property. Meanwhile, the significance of disaster education is becoming increasingly important. Despite natural disasters being hard to predict, people's responses to such events can be improved by education and training. Gamification, an innovative teaching method, has demonstrated great potential across various fields, including disaster education. We aimed to investigate the different application types of gamification in disaster education, focusing on nursing staff, medical professionals, university students, and disaster relief workers. Specifically, the goal was to identify the types of gamified teaching used in disaster education. This scoping review was conducted according to the Joanna Briggs Institute methodology. The Participants, Concept, Context (PCC) model was used to frame the inclusion criteria. We performed a systematic search of the relevant literature across the Cochrane Library, PubMed, CINAHL, Embase, Web of Science, CNKI, Wanfang, VIPC, and SinoMed databases. Articles published in Chinese and English were selected for the review. The search was conducted to identify literature published from the establishment of the respective databases to April 21, 2024. Two researchers independently screened the literature according to the inclusion and exclusion criteria and extracted the data. We included a total of 16 studies in this review, originating from 8 different countries. These studies involved 1744 participants: nursing students (n=451), medical students from other majors (n=420), college students (n=287), hospital decision makers (n=264), hospital medical staff (n=262), and disaster relief workers (n=60). The gamification approaches for teaching and learning encompassed the following 7 categories: tabletop games, serious games, scenario simulation games, virtual reality and mobile games, theme games, board games, and escape room games. The objectives of the studies were diverse. Three studies conducted randomized controlled trials, with only 1 performing a comparative analysis between different games. Two studies carried out long-term outcome evaluations. This scoping review explored 7 types of games for disaster education and provided evidence for future education and training. Further research is needed to establish a long-term evaluation mechanism and a better game-based teaching program to provide more insights into the future of disaster education.

Comparison of the Effectiveness of LAR and CURB-65 Scores in Determining Hospitalization Decisions in Acute Pneumonia Patients

Objective: This study aims to assess the efficiency of the Lactate/Albumin Ratio (LAR) and CURB-65 scoring in determining the need for hospitalization in acute pneumonia patients in the emergency department. Methods: Our study was conducted retrospectively in the emergency department of a tertiary hospital from February 1, 2024, to August 1, 2024. Patients who presented with lower respiratory tract infections and were diagnosed with acute pneumonia between 01.02.2024 and 01.08.2024 were included in our study. All patient information was collected from electronic medical records. Results: A total of 77 patients were included in the study, of which 30 were hospitalized. The mean age of the patients was 68.8 ± 12.2 years, and 46.8% (n=36) were male. When comparing patients discharged from the emergency department with those admitted to the hospital, the discharged group had lower respiratory rate, BUN, lactate, CURB-65, and LAR values, which were statistically significant (P

Public Hospital's Decision Analysis on Providing E-Visit Services

Public Hospital's Decision Analysis on Providing E-Visit Services

Characterizing Managerial Decision Making in Public Hospitals: A Case Study from Romania.

Our study investigates the primary characteristics of managerial decision-making processes in the public hospital units in Romania, particularly in the Northeast region. This research aims to delineate the decision-making model applied by managers in these units, considering the multitude of legislative, economic, technical, ethical, and organizational changes prompted by the pandemic. A mixed-method research approach was utilized, combining semi-structured interviews and autoethnography, to capture experiences, attitudes, perceptions, motivations, and ethical considerations of decision-makers within the healthcare system. The findings revealed that managerial decisions in public hospitals were influenced by unique elements such as the vulnerability and support needs of patients, the absence of a clear hierarchy, the personalized nature of healthcare services, the complexity of care processes, and the use of advanced technology. External factors, notably political and economic influences, alongside internal ethical dilemmas, significantly impacted decision making. This study identifies the reliance on evidence-based decision making and a consultative managerial style as key to addressing these challenges. This research contributes theoretically by comparing decision-making models and practically by identifying a decision-making model that includes forms, techniques, and tools that could guide managers in decision making in Romanian public hospitals.

FAKTOR YANG MEMPENGARUHI KEAKURATAN DATA SENSUS HARIAN RAWAT INAP DI RSUD DR. R SOEDARSONO PASURUAN

The process of operational planning and hospital decision making is assisted by the SIMRS system. Based on a preliminary survey conducted in the Medical Records section of RSUD doctors, R. Soedarsono found 400 SIMRS patient data and 300 manual patient data. Because staff members enter the same patient data multiple times, some of this data is duplicated. Information collected daily from short-term and inpatients is used for ongoing screening considerations from day to day, week to week, and month to month. The aim of this research is to find out what influences the accuracy of SIMRS daily inpatient census data. A quantitative approach with descriptive methods was used for this research. The subject of the examination was a medical records officer, while the object of exploration was a PC gadget. The results of the examination showed a variety of officers' information regarding using SIMRS: 20% inadequate, 40% adequate, and 40% good. The SIMRS strategy was seen as half inappropriate and half inappropriate, while the hardware was 60% complete and 40% short. Medical record officers should receive training on how to calculate daily inpatient census data correctly.

The use of the Roth score in emergency department for patients with acute exacerbation of chronic obstructive pulmonary disease

IntroductionThis study investigated the feasibility of using the Roth score in the emergency setting to make hospitalization or discharge decisions for patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Materials and methodsThis study was conducted prospectively between March 1, 2023 and January 1, 2024 and included 101 patients with Group E chronic obstructive pulmonary disease who were treated in the emergency department of a tertiary hospital. The patients were categorized into two groups: those who were hospitalized and those who were discharged. The Roth score, determined by measuring patients' breath-holding times after forced inspiration and counting rhythmically, was measured in seconds and counted. Changes in Roth scores, arterial blood gas parameters, and transcutaneous oxygen saturation levels measured during AECOPD presentation and after appropriate treatment were examined. ResultsThe study included 101 patients (57 males, 44 females) with a mean age of 61.4 years. After AECOPD treatment, the area under the curve for the Roth score was 0.937 s for the duration and 0.969 for the count. At a cut-off value of 9.5 s, the Roth score in seconds had a sensitivity of 92 % and a specificity of 75 %. At a cut-off value of 10.5, the Roth score had a sensitivity of 97 % and a specificity of 70 %. ConclusionThe Roth score (only counts) increased in discharged patients after AECOPD treatment. It appears to be a viable method for predicting hospitalization or discharge decisions in patients with AECOPD who present to the emergency department.

Who Makes Decisions in Hospital? A Scoping Review and Meta-Synthesis

Context: The aim of this study was to identify decision-making issues and key decision-makers within the hospital. Methods: This scoping review was conducted by searching the databases of Web of Science, Scopus, and PubMed in January 2024. Additionally, articles related to Newhouse's main article were searched on Google Scholar to identify decision-makers in the hospital and their areas of decision-making. The 37 articles were analyzed using the framework analysis technique with Atlas-ti software. Results: Decision-makers addressed 160 issues, which were identified and categorized into 7 areas: Strategic management, human resource management, financial management, physical resource management, employee compensation payment, service delivery management, and hospital reputation. Additionally, 21 decision-makers were identified and classified into 6 categories: Group of managers, group of physicians, group of nurses, board of directors, government, and political groups. Hospital managers were identified as the primary decision-makers, responsible for making decisions independently in three areas and jointly with the board of directors in one area. Conclusions: It can be concluded that no single decision-maker holds a dominant role in the decision-making process. Several decision-makers exert varying degrees of influence depending on the issue. Among these decision-makers, managers play a more significant role in decision-making than others.

Safety Outcomes After Sacubitril/Valsartan Initiation in a Community Teaching Hospital: A Retrospective Observational Study.

Sacubitril/valsartan is one of the main foundational medications in heart failure (HF), and recent data show that it provides a mortality benefit in this patient population. Some of the main safety concerns associated with this drug class include hypotension, hyperkalemia, angioedema, and acute kidney injury (AKI). Other studies have focused on sacubitril/valsartan effects on blood glucose levels, which is a newer concept that has not been as researched. This study seeks to explore the safety of angiotensin receptor-neprilysininhibitors (ARNi) when initiated in acute hospitalized patients, where data on tolerability will assist in patient selection and monitoring. The results of this study will help distinguish the HF population at a community teaching hospital and aid clinician decision-making. This was a single-center, retrospective, observational review utilizing electronic health records. To be included in this study, patients had to be 18 years or older with an HF diagnosis and must have taken at least two doses of sacubitril/valsartan before discharge. Primary safety outcomes will include discontinuation of sacubitril/valsartan, incidence of angioedema, hyperkalemia, AKI, hypotension, and hypoglycemia. Secondary outcomes included hospital length of stay and 30-day readmission rate. Data were collected for a total of 227 patients. AKI was the most common primary safety adverse effect captured with 30 patients (14.02%), followed by hypotension in 20 patients (9.35%), and hyperkalemia in 19 patients (8.9%). Only one patient (0.44%) experienced both angioedema and hypotension, and it happened to be the same patient. Additionally, only one patient (0.47%) was found to be hypoglycemic. Sacubitril/valsartan was discontinued in 41 patients (18.1%), and 20 of those patients (8.8%) were restarted at a lower dose. Lastly, 63 patients (27.8%) were readmitted within 30 days of discharge. Patents that also had diabetes had worse safety outcomes and were associated with 30-day readmission. Conclusions: This study of patients admitted with HF and started on sacubitril/valsartan found similar rates of efficacy and safety outcomes to previously published reports. However, the rate of hypoglycemia associated with sacubitril/valsartan was low in only one patient, and it was strongly associated with previous antidiabetic medication use. This differs from previously published reports and analyses on the association of sacubitril/valsartan and hypoglycemia. More research is needed for the argument that sacubitril/valsartan has an effect on glycemic outcomes. Patients with diabetes were found to have worse safety outcomes and a higher 30-day readmission. Providers should consider monitoring these patients closely and making sure that patients are on guideline-directed medication therapy before discharge. Other common safety events associated with sacubitril/valsartan were also seen in this population.

Does immunohistochemical marker conversion affect the prognosis in breast cancer patients receiving neoadjuvant chemotherapy?

Biomarkers such as hormone receptors (HR) and human epidermal growth factor receptor2 (HER2) may change after neoadjuvant chemotherapy (NAC) in breast cancer patients. The aim of this study was to investigate the rates of receptor change after NAC and to evaluate the prognostic impact of change. Patients with breast cancer who received NAC were included in the study. Changes in pathological findings (ER, PR, HER-2, Ki-67, grade) before and after NAC were examined. In addition, the effect of receptor exchange on prognosis was evaluated. Kaplan Meier analysis was used for survival analyses. Study was approved by Ethics Board of Tepecik Training and Research Hospital (Decision number 2021/10-02). We confirm that all methods were performed in accordance with relevant named guidelines and regulations. The study included 203 female patients. When pathological findings before and after NAC were compared, significant regression was found in grade and Ki-67 values (p = 0.003, p < 0.001). ER change rate was 11.8%, PR change rate was 24.6% and HER-2 change rate was 12.5%. No significant correlation was found between ER, PR and HER-2 changes and prognosis. The pathological T stage after NAC being 1 or 2, no lymph nodes detected, and the tumor grade being 1 or 2 were independent variables related to survival (p: 0.002, p: 0.014, p < 0.001). In patients with breast cancer, it would be appropriate to re-evaluate the HER-2 and HR status of the surgical specimen following NAC, especially in initially negative patients. The correlation of receptor discordance with prognosis is not clear and more extensive studies are needed.

Prediction of pharmaceutical and non-pharmaceutical expenditures associated with Diabetes Mellitus type II based on clinical risk.

To assess the effectiveness of different machine learning models in estimating the pharmaceutical and non-pharmaceutical expenditures associated with Diabetes Mellitus type II diagnosis, based on the clinical risk index determined by the analysis of comorbidities. In this cross-sectional study, we have used data from 11,028 anonymized records of patients admitted to a high-complexity hospital in Bogota, Colombia between 2017-2019 with a primary diagnosis of Diabetes. These cases were classified according to Charlson's comorbidity index in several risk categories. The main variables analyzed in this study are hospitalization costs (which include pharmaceutical and non-pharmaceutical expenditures), age, gender, length of stay, medicines and services consumed, and comorbidities assessed by the Charlson's index. The model's dependent variable is expenditure (composed of pharmaceutical and non-pharmaceutical expenditures). Based on these variables, different machine learning models (Multivariate linear regression, Lasso model, and Neural Networks) were used to estimate the pharmaceutical and non-pharmaceutical expenditures associated with the clinical risk classification. To evaluate the performance of these models, different metrics were used: Mean Absolute Percentage Error (MAPE), Mean Squared Error (MSE), Root Mean Squared Error (RMSE), Mean Absolute Error (MAE), and Coefficient of Determination (R2). The results indicate that the Neural Networks model performed better in terms of accuracy in predicting pharmaceutical and non-pharmaceutical expenditures considering the clinical risk based on Charlson's comorbidity index. A deeper understanding and experimentation with Neural Networks can improve these preliminary results, therefore we can also conclude that the main variables used and those that were proposed can be used as predictors for the medical expenditures of patients with diabetes type-II. With the increase of technology elements and tools, it is possible to build models that allow decision-makers in hospitals to improve the resource planning process given the accuracy obtained with the different models tested.

Investigation of the Relationship Between the Measured Alpha Angle in Capnography and Readmission Within Thirty Days in Chronic Obstructive Pulmonary Disease Patients Who Presented to the Emergency Department

BackgroundIndividuals with chronic obstructive pulmonary disease (COPD) constitute a significant portion of patients who present to the emergency department with dyspnea. However, there is no ideal method for predicting mortality or making hospitalization decisions in the emergency department (ED). In this regard, objective findings are needed for these patients. Since there are no objective findings regarding the hospitalization decision, there may be an increase in the re-admission rate of patients who needed hospitalization but were decided to be discharged. Side-stream end-tidal carbon dioxide (EtCO2) measurements offer a non-invasive, easy-to-interpret, quickly accessible, and reproducible method that can be applied at the bedside. ObjectivesThe aim of this study was to evaluate the relationship between the alpha angle values obtained by capnography and readmission rates within 30 days for patients experiencing COPD exacerbations who presented to the ED with dyspnea and were discharged after treatment. MethodsIn this study, we studied with 130 participants presented to the emergency department of a tertiary care university hospital with dyspnea, who are >18 y. Forty patients were excluded after evaluation for eligibility for the study. Thus, the data of 90 patients included were analyzed. We obtained alpha angle and EtCO2 values for all patients at the time of admission and also after treatment. The primary outcome measure of the study was the relationship between the patients’ readmission situations within 30 days of the alpha angle measurements. The secondary outcome measure was the association between patients’ EtCO2 values ​​and readmission within 30 days. ResultsIt was observed that both the pretreatment alpha angle values and the posttreatment alpha angle variables were statistically significant in predicting the readmission of the patients within 30 days (p = 0.001, p = 0.003) ConclusionThe results of this study show that alpha angle values measured for patients with COPD who present to the ED with the complaint of dyspnea may be used to predict readmission.

Forecasting hospital outpatient volume using an optimized medical two-stage hybrid grey model

PurposeForecasting outpatient volume during a significant security crisis can provide reasonable decision-making references for hospital managers to prevent sudden outbreaks and dispatch medical resources on time. Based on the background of standard hospital operation and Coronavirus disease (COVID-19) periods, this paper constructs a hybrid grey model to forecast the outpatient volume to provide foresight decision support for hospital decision-makers.Design/methodology/approachThis paper proposes an improved hybrid grey model for two stages. In the non-COVID-19 stage, the Aquila Optimizer (AO) is selected to optimize the modeling parameters. Fourier correction is applied to revise the stochastic disturbance. In the COVID-19 stage, this model adds the COVID-19 impact factor to improve the grey model forecasting results based on the dummy variables. The cycle of the dummy variables modifies the COVID-19 factor.FindingsThis paper tests the hybrid grey model on a large Chinese hospital in Jiangsu. The fitting MAPE is 2.48%, and the RMSE is 16463.69 in the training group. The test MAPE is 1.91%, and the RMSE is 9354.93 in the test group. The results of both groups are better than those of the comparative models.Originality/valueThe two-stage hybrid grey model can solve traditional hospitals' seasonal outpatient volume forecasting and provide future policy formulation references for sudden large-scale epidemics.

Factors driving differences in the adoption of quality management practices among hospitals: A two-phase, sequential mixed-methods analysis.

Although all hospitals aim to deliver high-quality care, there is considerable variation in their adoption of quality management (QM) practices. Organizational and environmental factors are known to drive strategic decision-making in hospitals, but their impact on the adoption of QM practices remains unclear. Our study aims to identify multiple organizational and environmental factors that explain variation in the adoption of QM practices among hospitals and to explore mechanisms underlying these relationships. We conducted a two-phase, sequential mixed-methods study of German acute care hospitals. The quantitative phase used between-effects regressions to identify factors explaining variation in the number of QM practices adopted by hospitals from 2015 to 2019. The qualitative phase used semistructured interviews with quality managers to gain in-depth insights. The number of QM practices adopted by a hospital was significantly associated with factors like hospital size and the presence of an emergency department or QM steering committee. Our qualitative findings highlighted potential mechanisms such as the presence of an emergency department serving as a proxy for organizational complexity or urgency of case-mix. We provide an overview of factors driving QM adoption in hospitals, extending beyond the focus on single factors in previous research. Future studies could explore additional factors highlighted by our interviewees. Our results can inform interventions to strengthen QM in hospitals and guide future research on this topic.

Hospitalization determinants in patients with Mpox disease: The CEME-22 Project

ObjectivesThis sub-analysis seeks to delineate and characterize factors influencing hospitalization in individuals diagnosed with Mpox disease amidst the initial outbreak in Spain in the onset of 2022. MethodsEmploying a non-probabilistic convenience sampling approach, a retrospective multicenter investigation was carried out to examine Monkeypox virus infection within Spanish healthcare facilities. ResultsThe median duration of the disease was 16 days, with 4.2 % of cases resulting in hospitalization. There was a single ICU admission leading to fatality. Sequelae were observed in 2.3 % of cases. Multivariate analysis revealed that hospitalization decisions were influenced by immunosuppression and severe symptoms, including gastrointestinal, neurological, ear-nose-throat, and respiratory manifestations. Significant analytical parameter differences were restricted to hemoglobin levels at diagnosis. ConclusionsThis study elucidates factors influencing hospitalization decisions for Monkeypox patients in Spain, emphasizing the importance of immunosuppression and extracutaneous symptoms involving the gastrointestinal, ear-nose-throat, and respiratory pathways. In summary, hospitalization determinations arise from the interplay of these crucial dimensions.

Identification of key potential risk areas and key potential failure modes in hemodialysis rooms by the FMEA method following routine prevention and control of the COVID-19 pandemic.

Hemodialysis is an important part of nosocomial infection prevention and control (IPC). This study aimed to identify the key potential risk areas and failure modes in hemodialysis rooms in hospitals and put forward a series of improvement measures to prevent and control the spread of the coronavirus disease 2019 (COVID-19). Hemodialysis patients are highly susceptible to COVID-19 and usually have a high incidence of severe illness and mortality after infection with COVID-19. Therefore, IPC in hemodialysis patients is of crucial strategic significance. Based on 30 domain experts' interviews and careful analysis of prevention and control documents, we constructed a comprehensive failure system for a model that identifies the potential risks for nosocomial COVID-19 infection in the hemodialysis room. Subsequently, a thorough risk assessment of the potential failure factors identified in our model was conducted. The failure key factors corresponding to the human element in medical waste (garbage) disposal (C2) are verified to be the highest risk factors. They are as follows: The cleaning staff did not dispose of different types of medical waste (garbage) (C21), did not wear masks according to the regulations (C22), and lacked knowledge and norms of nosocomial IPC (C23). This study provides valuable insights for hospital decision-makers on the potential failure factors related to COVID-19 infections in hemodialysis rooms. By working with hospital infection specialists, the suggested improvement measures can help reduce the risk of virus exposure among hospital medical staff, patients, and cleaning staff.

Pricing and Capacity Design for Profit-Driven and Welfare-Driven Healthcare Providers

In choosing healthcare services, price and waiting time are two important factors that matter to patients. Price is set by healthcare providers, while waiting time is usually endogenously determined by patient choice and the healthcare provider's capacity investment. We study the pricing and capacity design for profit-driven hospitals offering two types of healthcare services—regular and premium—serving heterogeneous patients who choose from either of the two types of services. Patients make their choices based on both price and endogenously determined equilibrium waiting time. We then benchmark profit-driven hospitals to welfare-driven hospitals to reveal how the behaviors of for-profit hospitals deviate from the socially optimal outcomes in patients waiting, service capacity, and price. We find that fewer patients are treated by premium services in profit-driven hospitals, and thus profit-driven hospitals invest less in premium service capacity and charge a higher premium for premium services than welfare-driven hospitals. These inefficiency distortions exist in profit-driven hospitals primarily because they are incentivized to differentiate between the waiting times of the two types of service to induce patients to pay a higher premium for premium services. Our results also show that if the inefficiency in patient partition is corrected, profit-driven hospitals would choose the welfare-maximizing level of premium service capacity and thus achieve socially optimal results. However, we also find that regulations such as price ceiling and capacity regulation cannot fully correct the inefficiency in patient partition and capacity decisions of profit-driven hospitals. Lastly, the model is extended in several ways to ensure robustness.