Value, efficiency, and technology in the changing healthcare environment

Healthcare in the United States costs too much, especially compared to other industrialized nations. There are two major components that account for the majority of healthcare costs in the U.S. – hospitalizations and physicians’ fees. The U.S.’s investment in healthcare is nearly double most other industrialized nations; yet, the care quality and number of people covered by insurance significantly lags comparable economies. These trends are neither competitively advantageous in the near term nor sustainable in the long term. Therefore, the dual needs of controlling costs and improving quality are becoming national priorities. However, there is a lack of actionable information for policymakers, managers and professionals seeking to address healthcare cost and quality issues.

The purpose of this dissertation is to examine the healthcare value proposition in terms of quality, efficiency, and the adoption of the information systems necessary to improve both. Specifically, three papers have been written. The first paper explores how to assess hospitals’ quality and efficiency in order to make performance and value creation comparisons. While organizational-level comparisons are critical to knowing where improvements are needed, a sine qua non for creating actionable interventions is having the patient-level information that aggregates to create the institutional experience.

A central tenant to most healthcare policy proposals is to address the need for controlling costs and improving quality is the requirement for every American to have an Electronic Health Record (EHR). However, physicians have been slow to adopt EHR technology for a number of reasons, including cost. Therefore, the failure to systematically collect care processes and outcome information represents a bottleneck for public policy makers’ attempts at improving the quality and efficiency of healthcare. The second of the three papers addresses the need for patient-level information and the required systems for collecting the raw data. Specifically, the second paper in this dissertation measures physician’ EHR adoption rates from 2001 to 2008 and forecasts future rates to assess how long this bottleneck will determine the critical path to an efficient U.S. health system.

The third paper delves deeper into the adoption phenomena. Specifically, this paper compares the perceived EHR value streams of those physicians who have adopted the EHR to the perceived value streams of those physicians who are planning to adopt the technology. Understanding the experienced versus anticipated barriers to physician EHR adoption will make removing the information bottleneck a more tractable problem.

The three papers in this dissertation examine the value and efficiency in the healthcare delivery process, moving from the macro to micro level. Paper one examines the macro level in a market-by-market analysis of firms to the micro level of individual physician practices. This strategy presents benefits in a threefold manner. First, healthcare faculty in business schools practice as generalists. These papers provide a foundation of the two largest healthcare segments, hospitals and physicians, in terms of building a research stream and teaching expertise for the future. Second, these papers allow for publishing in multiple domains. For example, the organization level examination provides for both strategy and organization theory topics. Analysis of technology adoption looks at both marketing and organizational behavior components of physician behaviors. Third, collectively, these papers provide publication opportunities in both general business literature and healthcare specific outlets. Evidence for the possibility of differing target journals comes via earlier versions of the papers finding acceptance at the Academy of Management and in healthcare journals.