Florida Tech Research Team:

1
The Impact of Alternative Health Delivery Policies

• Florida Tech Research Team
• Dr. Judith Barlow, Information Systems
• Dr. David Hott, Operations Research
• Dr. LuAnn Bean, Financial Accounting and IS
  Auditing

• Wales Research Team
• Dr. R. T. Edwards, Health Economist
• Dr. Angela Boland, Community Health
• Gethin Griffith, Research Fellow
• Cynog Prys, Health Statistician

These slides are available on the web at
http//my.fit.edu/jbarlow/health
2
Health Care Delivery System

• Components of the health care delivery system
  include physicians, clinics, hospitals, medical
  laboratories, tests.
• Each of these can be considered a scarce
  resource because demand for health care services
  is considerably greater than supply.
• A mechanism for equitably allocating scare
  resources is needed.
• In the UK, rationing of health care services is
  done via waiting lists. For example, patients
  desiring non-critical care join a non-prioritized
  waiting list and patients are selected for
  treatment on a first-come, first-served basis.

3
Rationing by Waiting Lists

• Waiting lists are the predominant mechanism for
  rationing non-urgent health care services used by
  the British National Health Service (NHS).
• Florida Tech simulation and modeling expertise is
  being used in the UK
• Lessons from the UK and collaborator expertise
  can be applied in the US.
• Similar scenarios in the US include HMOs,
  Veterans Hospitals, Medicaid, Medicare, and all
  treatment of uninsured patients.

4
Background

• Collaboration between Florida Tech School of
  Management, University of Bangor Centre for the
  Economics of Health, and North Wales Health
  Authority
• The focus of this collaboration is to simulate
  the impact of alternative criteria for selecting
  patients from hospital and clinic waiting lists.
  
• Details of this work has been published in
  several journals and presented at conferences,
  both in the USA and in Europe.
• The work has been funded by the NHS, Wellcome
  Trust, and the European Community Advanced
  Informatics in Medicine Program.

5
Alternative Waiting List Selection Alternatives

Current selection rule is first-come,
first-served.
6
Quality Adjusted Life Weeks (QALW) is a measure
of quality of life improvement from treatment

• QALW (1-m) (1-nr) (QT(D) QT(D)(1 M)
• Where
• QALW Net QALWs gained from treatment versus no
  treatment
• m Perioperative mortality
• nr no symptomatic relief from treatment
• QT(D) Gross QALW total by having treatment
  cumulative over patient lifetime and discounted
• QT(D) Pre-treatment quality of life score  

7
Selected Publications

• Edwards, Rhiannon Tudor and Judith Barlow,
  (1995)"Quantifying Equity Issues in the
  Management of Hospital Waiting Lists", European
  Journal of Operations Research.
• Barlow, Judith and Rhiannon Tudor Edwards, (1996)
  "Evaluating Quality and Equity Issues in the
  Management of Hospital Waiting Lists", IEEE
  Engineering Management Conference (IEMC '96).
• Edwards, R.T. (1996) Elective Waiting Lists Are
  Becoming Explicitly Rationed. BMJ, 313 558559.
• Barlow, Judith, Rhiannon Tudor Edwards and Angela
  Boland,(1996) "Weights For Waits Quantifying the
  Health Gain Implications of Setting Explicit
  Priorities in the Rationing of Health Care by
  Waiting Lists", presented at Priorities in Health
  Care Conference in Stockholm.
• Edwards, R.T. (1997) NHS Waiting Lists Towards
  the Elusive Solution. London Office of Health
  Economics.
• Edwards, R.T. (1999) Waiting List Priority
  Scoring Systems. BMJ, 318 412-413.
• Edwards, Rhiannon Tudor, Judith Barlow and David
  D. Hott, (2002) Impact of Alternative Health
  Needs Assessment Policies, IEMS 2002, Cocoa
  Beach.
• Edwards RT, Boland A, Wilkinson C, Cohen D,
  Williams JG. (2003) Clinical and Lay Preferences
  for Explicit Prioritisation of Elective Waiting
  Lists Survey Evidence from Wales. Health Policy
  63(3) 229-237.

8
Congressional Champion Tom Feeney

• Champion for senior health care. 
• In August 2002 he met with Central Florida
  Regional Hospital nurses, doctors and hospital
  administrators to learn more about medical
  malpractice crisis and spiraling insurance rate
  increases.
• Received a Service Award from Seminole Community
  Mental Health For "Extraordinary Commitment.
• Legislator of the Year Award FOMA for support of
  delivery of quality health care  in March 2002. 
• Received various health care honors and currently
  sits on 3 Congressional Committees. 
• He is in the 24th District - Northern Brevard
  County.