On the Impact of Treatment Restrictions for the Indigent Suffering from a Chronic Disease: The Case of Compassionate Dialysis

50 Pages Posted: 14 May 2021 Last revised: 2 Aug 2021

See all articles by Olga Bountali

Olga Bountali

Rotman School of Management, University of Toronto

Sila Cetinkaya

Lyle School Of Engineering, Southern methodist University

Vishal Ahuja

Southern Methodist University (SMU) - Information Technology and Operations Management Department (ITOM)

Date Written: May 7, 2021

Abstract

We analyze a congested healthcare delivery setting due to emergency treatment of a chronic disease on a regular basis. A prominent example of the problem of interest is congestion in the emergency room (ER) at a publicly-funded safety net hospital due to recurrent arrivals of uninsured end-stage renal disease (ESRD) patients needing dialysis (a.k.a., compassionate dialysis). Unfortunately, this is the only treatment option for un-/under-funded patients (e.g., undocumented immigrants) with ESRD, and it is available only when the patient's clinical condition is deemed as life-threatening after a mandatory protocol including an initial screening assessment in the ER as dictated and communicated by hospital administration and county policy. After the screening assessment, the so-called treatment restrictions are in place and a certain percentage of patients are sent back home{ER, thus, serves as a screening stage. The intention here is to control system-load, and, hence, overcrowding, via restricting service (i.e. dialysis) for recurrent arrivals due to the chronic nature of the underlying disease. In order to develop a deeper understanding of potential unintended consequences, we model the problem setting as a stylized queueing network with recurrent arrivals and restricted service subject to the mandatory screening assessment in the ER. We obtain analytical expressions of fundamental quantitative metrics related to network characteristics along with more sophisticated performance measures. The performance measures of interest include both traditional and new problem-specific metrics, such as those that are indicative of deterioration in patient welfare due to rejections and treatment delays. We identify cases where treatment restrictions alone may alleviate or lead to severe congestion and treatment delays, thereby impacting both the system operation and patient welfare. The fundamental insight we offer is centered around the finding that the impact of mandatory protocol on network characteristics as well as traditional and problem-specific performance measures is nontrivial and counterintuitive. However, impact is analytically and/or numerically quantifiable via our approach. Overall, our quantitative results demonstrate that the thinking behind the mandatory protocol is potentially naïve. This is because the approach does not necessarily serve its intended purpose of controlling system-load and overcrowding.

Note:
Funding Statement: This work has been funded by the SMU Lyle School of Engineering Seed Funding with matching funds from SMU Cox School of Business and in-kind support by Parkland Memorial Hospital, Dallas, TX

Declaration of Interests: No competing interest to declare.

Keywords: Open Jackson Networks, Queueing Theory, Healthcare Operations

Suggested Citation

Bountali, Olga and Cetinkaya, Sila and Ahuja, Vishal, On the Impact of Treatment Restrictions for the Indigent Suffering from a Chronic Disease: The Case of Compassionate Dialysis (May 7, 2021). SMU Cox School of Business Research Paper No. 21-06, Available at SSRN: https://ssrn.com/abstract=3835238 or http://dx.doi.org/10.2139/ssrn.3835238

Olga Bountali (Contact Author)

Rotman School of Management, University of Toronto ( email )

Toronto, Ontario M5S 3G8
Canada

Sila Cetinkaya

Lyle School Of Engineering, Southern methodist University ( email )

6212 Bishop Blvd.
Dallas, TX 75275
United States

Vishal Ahuja

Southern Methodist University (SMU) - Information Technology and Operations Management Department (ITOM) ( email )

Dallas, TX 75275
United States

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