As healthcare costs are rising globally and biologic treatments are a growing segment of the cost, governments have created biosimilar regulatory pathways in attempt to lower the costs of biologics. Biosimilars may be viewed as a “pure” or distinct type of process innovation completely separate from product innovation due to the Regulatory requirements and this novel phenomenon allows, perhaps for the first time, process innovation to be studied independently from product innovation. This phenomenon is researched using the competitive dynamic Awareness-Motivation-Capability (AMC) model structure. Since biosimilars are still relatively new, the impact of the biosimilars from a practical and academic viewpoint is emerging and in particular within the US market. This research creates a biosimilar model and metrics, filling a current gap in the literature, and quantitatively evaluates the actions that firms face regarding entering into the biosimilars market due to key metrics such as patent / portfolio risk, prior biologics or generic experience, strength of the R&D pipeline, and the firm’s R&D intensity. The biosimilar construct due to the strict regulatory pathway definition provides this unique and novel opportunity to study process innovation and the impact on competitive dynamics without the interference of product innovation. This research is anticipated to contribute to the practical and academic understanding of process innovation via the biosimilar phenomenon and the competitive dynamics of market entry as well as to promote further managerial research into this area of biosimilars. / Business Administration/Strategic Management

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This thesis argues for providing spiritual care in primary care for Massachusetts persons with disabilities having Medicare and Medicaid as their primary insurers. It outlines an advocacy strategy to (1) increase awareness of the importance of spiritual care as key to primary care, (2) get buy-in for spiritual care as an optional primary care service to Medicaid beneficiaries needing nonmedical supports and services to live in the community due to mental health diagnosis or physical disability, and (3) put forward a statutory or regulatory proposal requiring One Care plans to provide certified peer chaplains as a covered service starting 2023.

Master of Science / Department of Industrial & Manufacturing Systems Engineering / Malgorzata J. Rys / Emergency department (ED) overcrowding is a nationwide problem affecting the safety and preparedness of our health care system. Many hospital EDs face significant short and intense surges in demand on a daily basis. However, the surge in demand during disaster event is not short and intense, but it is a sustained one. In order to meet this sudden surge as defined above, hospital EDs need to be more prepared and efficient to cater to increased volume of demand involving huge uncertainties. This thesis looks at the creation and use of discrete event simulation modeling using ARENA 10.0 software. In this thesis, an attempt is made to show how the different arrival patterns and time durations for which victims keep arriving affect the EDs ability to treat the patients. It is shown, how the model can be used to estimate additional resources that would be required to accommodate additional patients within the ED. Various shapes of arrival distributions were tested for different time durations. It was found that the arrival distribution with parameters (3, 4), (3, 3), (4, 2) and (2, 4) did not challenge the institutional capacity. In other words, the hospital was able to treat all the patients without compromising the quality of care up to 24 hours. However, distribution with parameter (3, 2), (2, 2), (3, 1), (1, 2), (2, 3), (2, 1), (1, 4), (1, 3), (1, 1) and (0.5, 2) did affect the system performance. Under these distributions, there was at least one patient who was either dead, LWBS or diverted. This indicates the immediacy with which victims arriving under these distributions overwhelmed the limited resources Our aim was to study, how many more resources would the ED need in order to have zero critical expire, zero Left without Being Seen (LWBS) and zero patients diverted. Arrival distribution (1, 2) was randomly selected to study this objective and it was found that for a 24 hours of simulation run time, an additional of two full trauma resources were required in order to have zero critical expire in trauma rooms area and additional of five ED beds and three nurses were required in treatment area for patients with moderate severity to have zero LWBS. With these additional resources, the ED was also able to treat all the non disaster related patients thereby having zero patients diverted. The same procedure can be used to determine the number of additional resources ED would require to treat all the victims arriving with the rest of the arrival distribution for different time periods. The simulation model built would help the emergency planners to better allocate and utilize the limited ED resources in order to treat maximum possible patients. It also helps estimate the number of additional resources that would be required in a particular scenario.

<p> The purpose of this project was to locate a potential funding source and write a grant to create a psycho-educational group for family members of adults with a mental health diagnosis. With this program, family members can receive guided and educated support. The additional support they receive will assist them in becoming more supportive to their loved ones who have mental illnesses. The group would take place at Alma Family Services in Long Beach, California. A search was conducted to locate an appropriate funder for this project. The Ralph M. Parsons Foundation had specific criteria about what type of agencies they fund, which was met by the agency and the program. </p><p> Individuals who experience mental health challenges face many difficulties during their lives. The support of knowledgeable, understanding, and caring family members may reduce some of life's challenges for individuals who experience mental illness. If funded, the program would benefit families who need psycho-education about mental illness and assistance with mental health questions. The actual submission and/or funding of this grant was not a requirement for the successful completion of the project.</p>

Doctor of Philosophy / Department of Geography / Bimal K. Paul / Medical tourism comprises a phenomenon where over five million patients a year are traveling across international borders to obtain various forms of health care. Most of these patients travel from developed countries to developing countries, seeking highly invasive medical treatments to less invasive and recreational medical procedures. By the year 2012, the medical tourism industry generated over $100 billion with over 50 countries making it a priority in trade for their country. With active government promotions, India has become one of the leading destinations for medical tourism. The objective of this research was to answer the questions: 1) how do the attitudes and behaviors of patients towards the concept of medical tourism influence their decision to become a medical tourist; 2) why do medical tourists seek treatment in India; and 3) what are the issues and challenges they face before coming to India as well as while in India. Interviews of thirty-four foreign patients were conducted in six sites spread across the South-Indian cities of Bangalore, Hyderabad, and Chennai which revealed useful information in addressing the research objectives. The three most important reasons that these medical tourists chose India for their treatments were: 1) the high quality of the doctors and medical facilities in India, 2) the affordable cost of treatments, and 3) the availability of specific treatments that might not have been available in their home countries. Patients also researched the topic thoroughly before they came to India. Knowledge was gained primarily from the Internet, print media, television shows and friends. Overall, the patients had very positive attitudes towards medical tourism. Most of them felt that they could get treatment because of their positive opinion on medical tourism, their ability to get treatment if they desired, and support from their families and loved ones.

Commentators on U.S. health care policy have noted that the relative weakness of government institutions has left the allocation and financing of health care services to powerful interest groups. Until recently, the actions of state organizations as a major explanation for the organization of the market was seldom used. This dissertation evaluates the efficacy of a state centered approach to explaining Florida's health care politics. / Florida is used as a case study because of the dynamics of its economy, politics, and demography and its effect on the state's health care issues. Four questions guide the research. First, what are the State of Florida's interests in the market? Second, what strategies have state organizations pursued in Florida's interests? Third, to what degree do non-state organizations influence the development of the legislation? Finally, what conditions facilitate the involvement of Florida's state organizations in the health care services market? / Legislation regarding the enactment and continuance of Florida's Medicaid program, Florida's strategy for financing uncompensated hospital care, the financial arrangements for purchasing services, Florida's certificate of need licensing program, and Florida's regulation of hospital budgets is examined over a 28 year period, 1965 to 1993. / The investigation found that the interests of the State, defined by well accepted principles of its appropriate role, were strong enough to enable state agencies to successfully promote legislation authorizing and expanding Florida's Medicaid and indigent hospital care programs. Furthermore, on behalf of Florida's economic interests as a payer in the health care market, state agencies were successful in promoting legislation for alternative financial arrangements than fee for service and legislation regulating the capacity of the industry to produce health care services. / State agencies were successful in promoting these strategies when the interests of influential health care provider organizations were fragmented and, in some circumstances, when these organizations were united in their opposition to legislation promoting state strategies. In these circumstances, state agencies' efforts, influenced by federal monetary incentives, federal policy examples, and other state policy examples, set the agenda for the development of these strategies, not policy initiatives developed in the Legislature. / Source: Dissertation Abstracts International, Volume: 57-03, Section: A, page: 1344. / Major Professor: Allen Imershein. / Thesis (Ph.D.)--The Florida State University, 1996.

acase@tulane.edu

acase@tulane.edu

acase@tulane.edu