Can Patients Choose Their Hospital in a Pandemic?

by Bonnie Eissner

With the outbreak of Ebola in Africa and the looming threat of avian flu and other highly transmissible diseases, the threat of a pandemic has taken on a new urgency, at least in the public consciousness. According to Jiang Zhang, Ph.D., an associate professor at the Robert B. Willumstad School of Business, the U.S. government has been concerned for some time about the possibility of an influenza or avian influenza outbreak. What would this look like? The Center for Disease Control and Prevention Estimates that it could mean from just shy of a million to more than nine and a half million hospitalized victims.

Recently, Dr. Zhang, an operations management expert, teamed up with a colleague, Lihui Bai, Ph.D., an assistant professor in the Department of Industrial Engineering at the University of Louisville, to examine how patients can be enticed to choose the hospitals that will best serve them.

At the heart of the issue is the unequal distribution of hospitals and hospital beds. Urban areas, such as New York City, have larger, more prominent hospitals. But the demand for beds is much greater. During a pandemic, this imbalance could lead to bottlenecks at city and suburban hospitals, while rural hospitals remain underutilized.

How do you spur people to travel to the hospitals that will serve them most efficiently? One option is for the government to assign people to particular hospitals. Another is to entice them.

Dr. Zhang and Dr. Bai showed that an incentive-based model is as effective as an assignment-based model. And it’s likely to be more palatable.

They used a simple incentive: shorter wait times. According to the model, shorter wait times can be used to offset the time spent traveling to more distant hospitals. The model is akin to using tolls to encourage drivers to use less crowded roads, bridges and tunnels.

The study, published in 2014 in the International Journal of Mathematics in Operational Research, has drawn significant attention. Dr. Zhang said, “The reason our paper has been picked by the journal and sent out was because it’s relatively new…in this type of setting.”

Dr. Zhang noted that, as hospitals and doctors focus more on service delivery and cost savings, operations management models and expertise will become more relevant. Already, he is working on another hospital-related study, and he said that the physicians who participate in Adelphi’s M.B.A. program are showing increased interest in understanding how to apply business models to their own work. Both are examples of how operations management is becoming more interdisciplinary.