Competing Interests

Joel  Goh

Chapter | Handbook of Healthcare Analytics | 2018

Competing Interests

Abstract

Book Abstract: The editors, aided by a team of internationally acclaimed experts, have curated this timely volume to help newcomers and seasoned researchers alike to rapidly comprehend a diverse set of thrusts and tools in this rapidly growing cross-disciplinary field. The Handbook covers a wide range of macro-, meso- and micro-level thrusts—such as market design, competing interests, global health, personalized medicine, residential care, and concierge medicine, among others—and structures what has been a highly fragmented research area into a coherent scientific discipline. The Handbook also provides an easy-to-comprehend introduction to five essential research tools—Markov decision process, game theory and information economics, queueing games, econometric methods, and data science—by illustrating their uses and applicability on examples from diverse healthcare settings, thus connecting tools with thrusts. The primary audience of the Handbook includes analytics scholars interested in healthcare and healthcare practitioners interested in analytics.

Keywords: healthcare; analytics; Health Care and Treatment; Research; Competition;

Format: Print

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Citation:

Goh, Joel. "Competing Interests." Chap. 4 in Handbook of Healthcare Analytics: Theoretical Minimum for Conducting 21st Century Research on Healthcare Operations, edited by Tinglong Dai and Sridhar Tayur, 51–78. John Wiley & Sons, 2018.

Cost-effectiveness studies of medical innovations often suffer from data inadequacy. When Markov chains are used as a modeling framework for such studies, this data inadequacy can manifest itself as imprecision in the elements of the transition matrix. In this paper, we study how to compute maximal and minimal values for the discounted value of the chain (with respect to a vector of state-wise costs or rewards) as these uncertain transition parameters jointly vary within a given uncertainty set. We show that these problems are computationally tractable if the uncertainty set has a row-wise structure. Conversely, we prove that the row-wise structure is necessary for tractability. Without it, the problems become computationally intractable (strongly NP-hard). We apply our model to assess the cost effectiveness of fecal immunochemical testing (FIT), a new screening method for colorectal cancer. Our results show that despite the large uncertainty in FIT's performance, it could be cost-effective relative to the prevailing screening method of colonoscopy.

In December 2014, Dr. Anthony Furlan, chair of the Department of Neurology at University Hospitals Cleveland Medical Center (UH), faced a mandate from the hospital’s executive leadership team. Specifically, all UH departments were directed to take steps within six months to reduce the waiting time for outpatient appointments—measured as the time to first available outpatient appointment—to no more than 15 days. For Furlan and his colleagues in neurology, achieving this target was a significant challenge, as the department’s current time to first available appointment was 93 days. The case considers several alternatives for reducing waiting time in outpatient neurology without increasing the total clinical staff. The case allows students to evaluate opportunities for expanding the effective capacity of a complex service operation and to understand the tradeoffs between customer service and labor utilization.

Working Paper | HBS Working Paper Series | 2017

Intermediation in the Supply of Agricultural Products in Developing Economies

Kris Johnson Ferreira, Joel Goh and Ehsan Valavi

Problem Definition: Farmers face several challenges in agricultural supply chains in emerging economies that contribute to extreme levels of poverty. One common challenge is that farmers only have access to one channel, often an auction, for which to sell their crops. Recently, e-intermediaries have emerged as alternate, technology-driven posted-price channels. We aim to develop insights into the structural drivers of farmer and supply chain profitability in emerging markets and understand the impact of e-intermediaries.
Academic / Practical Relevance: In practice, much attention has been given to e-intermediaries and they have often been touted as for-profit social enterprises that improve farmers' welfare. Yet, studies in the operations literature that systematically analyze the impact of e-intermediaries are lacking. Our work fills this gap and answers practical questions regarding the responsible operations of e-intermediaries.
Methodology: We develop an analytical model of a supply chain that allows us to study several key features of intermediated supply chains. We complement the model's insights with observations from a numerical study.
Results: In the absence of an e-intermediary, auctions cause farmers to either overproduce or underproduce compared to their ideal production levels in a vertically integrated chain. The presence of an e-intermediary with limited market share improves farmers' profits; however, if the e-intermediary grows too large, it negatively impacts both farmers' and supply chain profits. Finally, as the number of farmers increases, farmers' profits approach zero, irrespective of the e-intermediary's presence.
Managerial Implications: Our results provide a balanced perspective on the value of e-intermediation, compared to the generally positive views advanced by case studies. For-profit e-intermediaries that also aim to improve farmers' livelihoods cannot blindly operate as pure profit-maximizers, assuming that market forces alone will ensure that farmers benefit. Even when e-intermediation benefits farmers, it is insufficient to mitigate the negative effects of supply fragmentation, suggesting that for farmers, market power is more important than market access.

Keywords: developing countries; agricultural supply chain; Intermediation; multiple cahnels; Walrasian auction; Developing Countries and Economies; Supply Chain; Distribution Channels; Profit; Agriculture and Agribusiness Industry;

Citation:

Ferreira, Kris Johnson, Joel Goh, and Ehsan Valavi. "Intermediation in the Supply of Agricultural Products in Developing Economies." Harvard Business School Working Paper, No. 18-033, October 2017. View Details

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