This dissertation consists of three essays in health economics concerned with measuring the determinants of health care resource utilization and health. In the first chapter, I study entry barriers in healthcare provider markets. In the U.S., proponents of regulatory entry barriers called CON programs claim that they reduce waste by limiting "unnecessary" entry. I examine CON programs in the dialysis industry, where their effects on market structure, access, health, costs, and welfare are poorly understood, and where patients are sensitive to access and quality. I combine quasi-experimental policy variation in low population areas with a structural model of patient preferences to find that marginal entrants improved access significantly, reduced hospitalization rates, and generated for patients the utility value of traveling 275-344 fewer miles per month; but there is evidence that they contributed even more to fixed costs. Using policy variation throughout North Carolina, I also find evidence that the NC dialysis CON program created a mechanism through which incumbents could block potential entrants by expanding in tandem with their local patient populations. Taken together, my findings suggest that stronger regulatory entry barriers in low population areas may raise total welfare at patients' expense---but they also amplify concerns that CON programs dampen competition statewide. In the second chapter, I study an empirical framework commonly used in health economics research to measure the impact of an event over time using observational data: the event study. Dating back to at least Snow (1855), event studies have been used in health economics research to study mortality, health care utilization, health insurance enrollment, provider competition, and much more. Under no anticipation and parallel trends assumptions, difference-in-differences are known to identify the event's average treatment effect on the treated when units experience one event at most. In this paper, I introduce a new event study framework to accommodate settings where units may experience multiple events. I introduce a matching estimator which consistently and transparently estimates the average treatment effect on the treated of a single event under generalizations of the conventional no anticipation and parallel trends assumptions. I show that the matching estimator is equivalent to a weighted least squares estimator for a particular set of weights. I also introduce a parallel pre-trends test which can be used to scrutinize these assumptions in the usual sense. Finally, I demonstrate in a series of Monte Carlo simulations that the estimator and parallel pre-trends test work well for a wide range of treatment effects, including dynamic, non-stationary, and history-dependent treatment effects. In the third chapter, I study when and why emergency departments initiate ambulance diversions, and what happens to diverted patients. Efficiently distributing scarce healthcare resources among patients with time sensitive healthcare needs and uncertain arrival rates is a hard problem. When an emergency department gets too full, ED managers sometimes request that incoming ambulances reroute their patients to alternative destinations. While such ambulance diversions can sometimes help an overcrowded ED manage its caseload, it can also harm incoming patients and reduce systemwide EMS responsiveness. In detailed administrative records cataloging when, where, and why diversions occur, as well as who got diverted, I document that diversions commonly last exactly 1 hour, approximately 4 hours, and exactly 8 hours (indicating that managerial frictions may directly affect ED availability); that diverted patients have different characteristics than non-diverted patients (including potentially more severe symptoms); and that diverted patients spend 65% longer on the road to the hospital than non-diverted patients. I also find that diversions often occur not only because of crowdedness, but also because of hospital systems failures. I identify directions for future research.

Thesis. 1975. Ph.D.--Massachusetts Institute of Technology. Dept. of Electrical Engineering and Computer Science. / Vita. / Bibliography: leaves 187-192. / Ph.D.

The overriding goal of this work was to present information to ambulance command and control (AC2) operators in a manner that complemented their dispatchers decision making processes whilst minimising the effects of a number of identified complexities. It was theorised that presenting information in this manner would improve the decision making performance of the dispatchers. The initial stages of this work involved identifying the strategies that AC2 operators use when making decisions regarding the allocation of ambulances to emergency incidents and the complexities associated with these decisions. These strategies were identified after the analysis of interviews with AC2 operators using an interview approach called the Critical Decision Method. The subsequent analysis of the interview transcripts using an Emergent Themes Analysis provided a significant number of insights regarding the decision making processes of the operators and the information required to support these decisions. Of particular significance was the importance of situation awareness in the decision making process. For example, when dispatchers have a sound understanding of incidents and additional factors such as the ambulances under their control, the dispatch decision becomes less complicated. To extend the understanding of the dispatcher�s work in the communication centres, a number of factors that could contribute to the complexity of the dispatch task were identified from an additional analysis of the interview transcripts. However it was not possible to establish from this the contribution of these factors to the perceived complexity encountered by the operators. To address this, a questionnaire was circulated requiring dispatchers to rate the contribution of a number of factors to the complexity of the dispatch task and the frequency that these factors occurred. The results showed that the most prevalent factors related to a number of the cognitive processes that the dispatchers performed to manage the dispatch task. Such processes included determining the resource most likely to arrive at the scene of an emergency incident the quickest. There were also differences in regard to which areas of the dispatch process the dispatchers in the two centres considered to be the most complex. The final stage of this research was the design of a prototype interface that complemented the decision making strategies used by the dispatchers and addressed the identified complexities. At this stage the scope of the research was narrowed to focus primarily on the resource assessment and allocation phases of the dispatch process and several of the complexities associated with these. The prototype interface made use of a novel display technology that allowed the presentation of information across two overlapping LCD displays (referred to as a Multi Layered Display (MLD)). To test the effectiveness of this display a laboratory experiment was conducted comparing the perfomance of participants using the MLD with participants using a Single Layered Display (SLD) that presented the same information. The results indicated that in almost all cases the participants using the multi layer display performed better. However these differences did not prove to be significant.

<p>Syftet med denna studie är att beskriva och analysera anställdas uppfattning om förändringen av arbetstider inom sjuktransportsförvaltningen Halland. Följande frågor har ställts: Hur upplevde anställda arbetstidsförändringen inom ambulanssjukvården? På vilket sätt gavs de anställda möjlighet att vara delaktiga i arbetstidsförändringen? För att besvara dessa frågor har individuella intervjuer med sju anställda genomförts. Resultatet visar att det fanns både en positiv inställning och ett visst motstånd till förändringen. Den positiva inställningen kan förklaras genom att ledningen tagit hänsyn till åsikter som funnits angående förändringsarbetet. När det gäller motståndet var både en högre kostnad för arbetsgivaren och en lägre lön för de anställda bidragande orsaker i kombination med en upplevd osäkerhet inför en minskad möjlighet till långledighet. Den utbredda motivationen och engagemanget för arbetstidsförändringen hos de anställda har enligt oss flera orsaker. Främst är det en förändring som förbättrar de anställdas arbetstider och ger större möjligheter till sociala aktiviteter, tid med familjen samt vila och avkoppling. Andra orsaker kan ha varit de goda möjligheterna som de anställda gavs från ledningsgruppen att få vara delaktiga och vara med och påverka arbetsprocessen, vidare gavs möjlighet till inflytande i de olika beslut som fattades. Kommunikation som funnits mellan anställda och ledningsgrupp har främjat möjligheten till frågor och respons kontinuerligt under hela förändringsarbetet.</p> / <p>The purpose of this study is to investigate employees’ experience of a change project at the Halland County Council ambulance service. To answer the question, a qualitative method was used. The following questions were asked: How did the employees within the ambulance service experience the work time change? How did the employees participate in the work time change? Individual interviews were conducted with seven employees. The results showed most employees were positive to change, but that there was some resistance to the reduced working time. The positive attitude explanation may lie in the direction taken to views that existed on the change process into account. The resistance was due to both a higher cost to the employer and lower pay for employees contributing causes combined with a perceived uncertainty about the reduced possibility of long holidays. The widespread motivation and commitment had several reasons. Foremost it is a change that improves the employees' working time and provide more opportunities for social activities and recovery. Other causes may have been the possibility that they were given to participate, have a voice in the work and the opportunity to influence in the decision making. Communication that existed between employees and management team promoted the possibility of questions and feedback continuously throughout the change process.</p>

No description available.

Syftet med denna studie är att beskriva och analysera anställdas uppfattning om förändringen av arbetstider inom sjuktransportsförvaltningen Halland. Följande frågor har ställts: Hur upplevde anställda arbetstidsförändringen inom ambulanssjukvården? På vilket sätt gavs de anställda möjlighet att vara delaktiga i arbetstidsförändringen? För att besvara dessa frågor har individuella intervjuer med sju anställda genomförts. Resultatet visar att det fanns både en positiv inställning och ett visst motstånd till förändringen. Den positiva inställningen kan förklaras genom att ledningen tagit hänsyn till åsikter som funnits angående förändringsarbetet. När det gäller motståndet var både en högre kostnad för arbetsgivaren och en lägre lön för de anställda bidragande orsaker i kombination med en upplevd osäkerhet inför en minskad möjlighet till långledighet. Den utbredda motivationen och engagemanget för arbetstidsförändringen hos de anställda har enligt oss flera orsaker. Främst är det en förändring som förbättrar de anställdas arbetstider och ger större möjligheter till sociala aktiviteter, tid med familjen samt vila och avkoppling. Andra orsaker kan ha varit de goda möjligheterna som de anställda gavs från ledningsgruppen att få vara delaktiga och vara med och påverka arbetsprocessen, vidare gavs möjlighet till inflytande i de olika beslut som fattades. Kommunikation som funnits mellan anställda och ledningsgrupp har främjat möjligheten till frågor och respons kontinuerligt under hela förändringsarbetet. / The purpose of this study is to investigate employees’ experience of a change project at the Halland County Council ambulance service. To answer the question, a qualitative method was used. The following questions were asked: How did the employees within the ambulance service experience the work time change? How did the employees participate in the work time change? Individual interviews were conducted with seven employees. The results showed most employees were positive to change, but that there was some resistance to the reduced working time. The positive attitude explanation may lie in the direction taken to views that existed on the change process into account. The resistance was due to both a higher cost to the employer and lower pay for employees contributing causes combined with a perceived uncertainty about the reduced possibility of long holidays. The widespread motivation and commitment had several reasons. Foremost it is a change that improves the employees' working time and provide more opportunities for social activities and recovery. Other causes may have been the possibility that they were given to participate, have a voice in the work and the opportunity to influence in the decision making. Communication that existed between employees and management team promoted the possibility of questions and feedback continuously throughout the change process.

No description available.

published_or_final_version / Public Administration / Master / Master of Public Administration

published_or_final_version / Architecture / Master / Master of Architecture

The overriding goal of this work was to present information to ambulance command and control (AC2) operators in a manner that complemented their dispatchers decision making processes whilst minimising the effects of a number of identified complexities. It was theorised that presenting information in this manner would improve the decision making performance of the dispatchers. The initial stages of this work involved identifying the strategies that AC2 operators use when making decisions regarding the allocation of ambulances to emergency incidents and the complexities associated with these decisions. These strategies were identified after the analysis of interviews with AC2 operators using an interview approach called the Critical Decision Method. The subsequent analysis of the interview transcripts using an Emergent Themes Analysis provided a significant number of insights regarding the decision making processes of the operators and the information required to support these decisions. Of particular significance was the importance of situation awareness in the decision making process. For example, when dispatchers have a sound understanding of incidents and additional factors such as the ambulances under their control, the dispatch decision becomes less complicated. To extend the understanding of the dispatcher�s work in the communication centres, a number of factors that could contribute to the complexity of the dispatch task were identified from an additional analysis of the interview transcripts. However it was not possible to establish from this the contribution of these factors to the perceived complexity encountered by the operators. To address this, a questionnaire was circulated requiring dispatchers to rate the contribution of a number of factors to the complexity of the dispatch task and the frequency that these factors occurred. The results showed that the most prevalent factors related to a number of the cognitive processes that the dispatchers performed to manage the dispatch task. Such processes included determining the resource most likely to arrive at the scene of an emergency incident the quickest. There were also differences in regard to which areas of the dispatch process the dispatchers in the two centres considered to be the most complex. The final stage of this research was the design of a prototype interface that complemented the decision making strategies used by the dispatchers and addressed the identified complexities. At this stage the scope of the research was narrowed to focus primarily on the resource assessment and allocation phases of the dispatch process and several of the complexities associated with these. The prototype interface made use of a novel display technology that allowed the presentation of information across two overlapping LCD displays (referred to as a Multi Layered Display (MLD)). To test the effectiveness of this display a laboratory experiment was conducted comparing the perfomance of participants using the MLD with participants using a Single Layered Display (SLD) that presented the same information. The results indicated that in almost all cases the participants using the multi layer display performed better. However these differences did not prove to be significant.