Optimal Hospital Care Scheduling During the SARS-CoV-2 Pandemic

The COVID-19 pandemic has seen dramatic demand surges for hospital care that have placed a severe strain on health systems worldwide. As a result, policy makers are faced with the challenge of managing scarce hospital capacity to reduce the backlog of non-COVID patients while maintaining the ability to respond to any potential future increases in demand for COVID care. In this paper, we propose a nationwide prioritization scheme that models each individual patient as a dynamic program whose states encode the patient's health and treatment condition, whose actions describe the available treatment options, whose transition probabilities characterize the stochastic evolution of the patient's health, and whose rewards encode the contribution to the overall objectives of the health system. The individual patients' dynamic programs are coupled through constraints on the available resources, such as hospital beds, doctors, and nurses. We show that the overall problem can be modeled as a grouped weakly coupled dynamic program for which we determine near-optimal solutions through a fluid approximation. Our case study for the National Health Service in England shows how years of life can be gained by prioritizing specific disease types over COVID patients, such as injury and poisoning, diseases of the respiratory system, diseases of the circulatory system, diseases of the digestive system, and cancer.

Optimizing social and economic activity while containing SARS-CoV-2 transmission using DAEDALUS

To study the trade-off between economic, social and health outcomes in the management of a pandemic, DAEDALUS integrates a dynamic epidemiological model of SARS-CoV-2 transmission with a multi-sector economic model, reflecting sectoral heterogeneity in transmission and complex supply chains. The model identifies mitigation strategies that optimize economic production while constraining infections so that hospital capacity is not exceeded but allowing essential services, including much of the education sector, to remain active. The model differentiates closures by economic sector, keeping those sectors open that contribute little to transmission but much to economic output and those that produce essential services as intermediate or final consumption products. In an illustrative application to 63 sectors in the United Kingdom, the model achieves an economic gain of between £161 billion (24%) and £193 billion (29%) compared to a blanket lockdown of non-essential activities over six months. Although it has been designed for SARS-CoV-2, DAEDALUS is sufficiently flexible to be applicable to pandemics with different epidemiological characteristics. © 2022, The Author(s), under exclusive licence to Springer Nature America, Inc.

Building on value-based health care: Towards a health system perspective

Preoccupation with the value created by health systems has been longstanding, and will likely only intensify given the ongoing health systems strains and shocks such as the COVID-19 pandemic. But the focus so far has usually been limited to value as seen from the perspectives of certain actors in the health system and/or to certain dimensions of value. In this policy brief we call for a shared understanding of value that embraces the health system in its entirety, including preventive services and other public health functions. We then define value to be the contribution of the health system to societal wellbeing. Any meaningful formulation of the concept of wellbeing includes health, and by extension health systems, as an important contributor to our wellbeing. Health improvement, responsiveness, financial protection, efficiency and equity are widely accepted as health systems' core contributions to wellbeing. Health systems can also contribute to wellbeing indirectly through the spillover effects that its actions have on other sectors. Health systems are shaped by a wide array of actors, including national policy-makers, purchasers, providers, practitioners, citizens and patients. These different actors make important but discrete contributions to value, so in order to maximize it, their actions should be aligned. The aim should be to create a value-based health system. A range of policy levers can be used to enhance value, ranging from cross-sectoral policies to involving patients in decision-making. While such levers normally focus on one or two dimensions of value, it is important to ensure that they do not undermine other dimensions or the efforts of other actors. Effective governance of the whole health system is needed to ensure that stakeholder perspectives and policy levers are aligned to promote a common concept of health system value and, ultimately, of societal wellbeing. There are governance tools, such as the Transparency, Accountability, Participation, Integrity and Capacity (TAPIC) framework, that can help achieve this. Moving towards a value-based health system will often be a gradual process, focusing first of all on the areas where it might make the biggest difference.